Annual Report and Accounts - Bridgewater Community Healthcare

Transcription

Annual Report
and Accounts
2014/15
(part year: 1 November 2014 to 31 March 2015)
Bridgewater Annual Report 2014/15
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Bridgewater Community
Healthcare NHS
Foundation Trust
Annual Report and Accounts
2014/15
(part year : 1 November 2014 to 31 March 2015)
Presented to Parliament pursuant to Schedule 7
paragraph 25 (4) (a) of the National Health Service Act 2006
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Contents
Page
1: Statement from Chairman and Chief Executive
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2. Statement of the Chief Executive’s responsibilities as the Accounting 9
Officer of Bridgewater Community Healthcare NHS Foundation Trust
3: Strategic Report
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4: Directors’ Report
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5: Enhanced Quality Governance Reporting 84
6: Remuneration Report
85
7: Annual Governance Statement
91
8: Full Annual Accounts for the part year ended 31 October 2014
102
9: Appendices
Appendix 1: Board Attendance for year ended 31 March 2014 149
Appendix 2: Register of Director Attendance at Committee meetings
for year ended 31 March 2014
Appendix 3: Register of Director and Governor Attendance at Council
of Governor meetings for year ended 31 March 2015
152
Appendix 4: Quality Report 2014/15 155
150
10. Useful Contacts
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1.
Statement from Chairman and Chief Executive
We are delighted to present our first Annual Report and Accounts as an NHS Foundation
Trust for the period 1 November 2014 to 31 March 2015. This part year report covers the
accounts and highlights for the first five months as Bridgewater Community Healthcare NHS
Foundation Trust (Bridgewater).
This has been a very exciting time for the Trust as we made history on 1 November 2014 by
becoming one of the first two NHS community trusts to be awarded Foundation Trust status.
This was a milestone for NHS community healthcare and identified Bridgewater as well
managed, well governed leaders in the provision of high quality and safe community
healthcare. The fact that we achieved Foundation Trust status at this stage shows that we
have a major part to play in health services in this region and beyond. Our Foundation Trust
licence gives us a sound footing on which to continue to develop our specialism in
community service provision and support the implementation of new models of care outlined
in the Five Year Forward View by NHS England and other national bodies.
We achieved our Foundation Trust licence in the same week as we signed up our 10,000th
public member. This wide membership base provides us with a fantastic opportunity to
engage and involve our members in developing services for our communities.
These achievements would not have been possible without the hard work and commitment
of our staff and our Board, or conceivable without the support of our patients, members and
partners. A great deal of hard work from a lot of people went into preparing us to become a
Foundation Trust and it really is just the beginning of our story.
The main focus in the five months since we became a Foundation Trust has been the
introduction of the Listening into Action programme which aims to build a culture and way
of working that engages and empowers staff to make changes. During the period covered
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by this report we have seen some real changes within the Trust, re-energising how we listen
to staff and how we handle their feedback and I am confident that there will be significant
changes to come.
In addition, we are already seeing changes to how our members and governors are involved
in the Trust and are making a real contribution in many areas. We look forward to seeing their
involvement increase steadily so that we realise all the benefits of being a Foundation Trust.
At the end of the year we celebrated our staff awards, which is always an inspiring event as
we see first-hand some of the best and most touching examples of patient care. This is what
our Trust is all about: care, compassion and quality.
We continue to strive to improve quality and the experience of our patients. Details of how
we continually improve quality and monitor our progress are available in the 2014/15 Quality
Report contained within this report.
As we enter our first full year as a Foundation Trust in 2015/16 we have many challenges. The
Trust will begin the year with a new Chief Executive, Colin Scales, as Dr Kate Fallon retired
at the end of March. We continue, like other public sector providers, to face tough financial
conditions and increasing demand for services.
We take heart that we are facing the future as a leader in our field and with staff who have
the best interests of our patients at heart. We look forward to working more closely with our
members and governors to ensure that our strategy and objectives are truly responsive to our
local communities and deliver the services they need.
A part year annual report and accounts is also available for the period 1 March 2014 to 31
October 2014 when we were operating as an NHS Trust.
Colin Scales
Chief Executive Officer
Harry Holden
Chairman
Statement from Dr Kate Fallon, Outgoing Chief Executive
(Retired 31st March 2015)
As Accounting Officer for the period in which this report refers, I can confirm that I concur with
the contents of the annual report and accounts as they are presented.
I would like to take this opportunity to wish the organisation all the best for the future; it has
been a pleasure serving as Chief Executive of Bridgewater for the past four years.
Dr. Kate Fallon
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2.
Statement of the Chief Executive’s responsibilities as the accounting officer of Bridgewater Community Healthcare NHS Foundation Trust
The NHS Act 2006 states that the Chief Executive is the accounting officer of the NHS
Foundation Trust. The relevant responsibilities of the accounting officer, including their
responsibility for the propriety and regularity of public finances for which they are answerable,
and for the keeping of proper accounts, are set out in the NHS Foundation Trust Accounting
Officer Memorandum issued by Monitor.
Under the NHS Act 2006, Monitor has directed Bridgewater Community Healthcare NHS
Foundation Trust to prepare for each financial year a statement of accounts in the form and
on the basis set out in the Accounts Direction. The accounts are prepared on an accruals
basis and must give a true and fair view of the state of affairs of Bridgewater Community
Healthcare NHS Foundation Trust and of its income and expenditure, total recognised gains
and losses and cash flows for the financial year.
In preparing the accounts, the Accounting Officer is required to comply with the requirements
of the NHS Foundation Trust Annual Reporting Manual and in particular to:
• Observe the Accounts Direction issued by Monitor, including the relevant accounting
and disclosure requirements, and apply suitable accounting policies on a consistent
basis;
• Make judgements and estimates on a reasonable basis;
• State whether applicable accounting standards as set out in the NHS Foundation Trust
Annual Reporting Manual have been followed, and disclose and explain any material
departures in the financial statements;
• Ensure that the use of public funds complies with the relevant legislation, delegated
authorities and guidance; and
• Prepare the financial statements on a going concern basis.
The Accounting Officer is responsible for keeping proper accounting records which disclose
with reasonable accuracy at any time the financial position of the NHS foundation trust and
to enable him to ensure that the accounts comply with requirements outlined in the above
mentioned Act. The Accounting Officer is also responsible for safeguarding the assets of the
NHS foundation trust and hence for taking reasonable steps for the prevention and detection
of fraud and other irregularities.
To the best of my knowledge and belief, I have properly discharged the responsibilities set
out in Monitor’s NHS Foundation Trust Accounting Officer Memorandum.
Colin Scales
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3. Strategic Report
Profile of the Trust
Bridgewater Community Healthcare NHS Foundation Trust (Bridgewater) is a leading
provider of community health services in the North West of England. Established as a NHS
Trust in November 2010, Bridgewater was awarded NHS Foundation Trust status by Monitor
on 1 November 2014 and the Trust name was changed to Bridgewater Community
Healthcare NHS Foundation Trust.
Our business is to provide community and specialised health services to 831,270 people
living in Halton, St Helens, Warrington and Wigan. As a leading provider of community and
specialist health services, we also deliver community dental services in these boroughs plus
Bolton, Tameside, Glossop, Stockport and Western Cheshire. Our specialist health services in
other areas include a GP practice in Willaston, Western Cheshire, lifestyle services in Western
Cheshire and sexual health services in Trafford.
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Our business model
Our mission is to improve local health and wellbeing in the communities we serve and we are
working with our commissioners and partners to bring more care closer to home. The
majority of our services are delivered in patients’ homes or close to where they live, such as
clinics, health centres, GP practices, community centres and schools.
Covering four boroughs in the provision of core community services and a further five
boroughs in its provision of specialist dental services, we operate in a complex health and
social care market where many of our partners are also our competitors. We have a number
of different commissioners in each borough including Clinical Commissioning Groups and
Local Authorities.
The business model for Bridgewater is that of a corporate hub, providing strategic
leadership, governance and support services to the local clinical directorates, with each
having its own contract and cost centre. This enables us to offer locally designed services,
meeting locally identified demand and patterns of need.
We provide universal lifelong care to individuals and communities to improve health and
wellbeing of the whole population and specialist care for vulnerable people.
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Specialists Care for Vulnerable
Minorities
Cost benefit of large population
base for small volume services
Personal Care for Long-Term
Conditions
Working in partnership avoiding
admissions. Improving outcomes
Universal Services - Early Years
to End of Life
0-19 yrs, frail elderly, dementiaco-ordinating services for maximum impact
Self-Care and Wellbeing
Services for Whole Populations
Better health, better value
management
The population we serve is living longer, however there is a prevalence of long term
conditions such as diabetes, heart disease, lung disease and dementia. The geography of
Bridgewater includes some of the most deprived communities in England, with the
associated health and lifestyle challenges. We are uniquely placed to support a reduction in
avoidable attendance and admission to hospital, working in partnership with patients,
families and general practices. We are increasingly developing the provision of integrated
care with hospitals and local authority partners.
Our Foundation Trust status supports real and meaningful engagement with our patients,
partners and communities, through our active Council of Governors and over ten thousand
Members.
At 31 March 2015 we employed 2784 WTE people – the majority of whom are frontline
healthcare staff.
Our income for the part year 1 November 2014 to 31 March 2015 totalled £63.07m including
£53.4m Clinical Commissioning Groups and NHS England, £6.8m from local authorities,
£1.0m from NHS Health Education and £0.3m from other NHS Trusts.
The income from the provision of goods and services for the purposes of the Heath Service
in England is greater than our income from the provision of goods and services for any other
purposes. (As per section 43(2a) of the NHS Act 2006 (as amended by the Health and Social
Care Act 2012)).
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Our Services
Bridgewater is commissioned to deliver a diverse range of community healthcare services in
a number of boroughs including Halton, St Helens, Warrington and Wigan.
Our staff work in GP practices, health centres, schools and in many cases patients’ own
homes.
The Trust also provides one inpatient unit, Newton Community Hospital, which has 30 beds
plus outpatient facilities. We also deliver intermediate care and nursing support at Padgate
House, Warrington, a facility owned and managed by Warrington Borough Council which
provides care for 35 patients. Our therapists provide intermediate care and rehabilitation to
patients at Alexander Court care home in Wigan.
Our community dental services carry out specialised clinical procedures for the specific
needs of vulnerable people and children.
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Indicator to
be measured
2013/14
full year
position
2012/13
full year
position
Comments
Many of our services support people throughout their lives and as a provider of care our
focus is to keep people out of hospital. We provide ongoing care and support to vulnerable
people and those with complex and long-term conditions.
The delivery of services is organised into operational directorate structures to support the
delivery of a Bridgewater standard of service in all areas that we serve. These directorates
are Adults Services Directorate, Children and Families Services Directorate and Specialised
Services Directorate. Each is led by a general manager and supported by service managers
and clinical managers for each care group.
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A summary of our services
Adult Services
Service
Adult Continence
Cancer & Palliative Care - medical
Cancer & Palliative Care Specialist Nursing & Therapists
Care Home Support
Lymphoedema Service
Community Matrons
Integrated Teams
District Nursing Domiciliary service
District Nursing Out of Hours Service & evenings
District Nursing Ear Care Service
District Nursing Phlebotomy
District Nursing Tissue Viability
District Nursing Treatment Rooms
District Nursing Support to Care Homes
Stoma Care
Community Intravenous Therapies
Community Neurology Rehabilitation
Acquired Brain Injury
Parkinson’s Nursing
Chronic Fatigue Syndrome
Community Neurosciences
Community Integrated Equipment Service
Cardiac Rehabilitation
Diabetes
Respiratory/Chronic Obstructive Pulmonary Disease (COPD)
Heart Failure
Stroke Service
Ear Nose and Throat
Musculoskeletal Clinical Assessment & Treatment Services
(MSKCATS)
Physio/Orthopaedics/Musculoskeletal
Podiatry & Biomechanics Service
Wheelchair, Specialist Seating
Driving Assessment Services
Falls & Community Therapy
Intermediate Care
Community Hospital
Early Support Discharge Team
GP Out of Hours
Walk in Centre
Pain Management
Wigan
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St Helens
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Warrington
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Halton
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Children and Famillies’ Services
Service
Children’s Audiology
Newborn Hearing screening
Child and Adolescent Mental Health Service
Eating Disorder Service
Child Safeguarding/Looked After Children
Children’s Development
Children’s Therapies including Occupational Therapy,
Physiotherapy, Speech & Language Therapy
Children’s Community Learning Disability Service
Children’s Community Nursing & Complex Needs
Children’s Continence
Children’s Continuing Healthcare
Children’s Respiratory
Children’s Long Term Conditions
Child Health Service
Children Young People & Families Acute Community Nursing
Team
Minor Illness Prevention Service
School Nursing
Health Visiting
Midwifery
Paediatric Liaison
Surgical Appliances
Child Health System Team
Wigan
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St Helens
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Warrington
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Halton
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St Helens
Warrington
Halton
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Specialised Services
Service
Adult Learning Disability
Breastfeeding Support
Community Dental Services *
Community Mental Health
Counselling Services
Dietetics (Children Young People & Families)
Dietetics
Diabetic Eye Screening
Dermatology
Health Improvement
Stop Smoking
Neighbourhood Mums
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Wigan
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Specialised Services
Service
Homeless and Vulnerable
Open Mind
Offender Health
Sexual Health **
Speech and Language Therapy (Adults)
Weight Management
Wigan
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St Helens
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Warrington
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Halton
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Notes
* Bridgewater also provides community dental services in Bolton, Tameside, Glossop,
Stockport and western Cheshire
**Bridgewater also provides sexual health services in Trafford
Please note: Bridgewater also provides a child lifestyle service in Western Cheshire.
As of 1st July 2014, Bridgewater delivers general practice services from the Willaston Surgery
in Willaston, Western Cheshire.
Please note: these tables do not include every service Bridgewater is commissioned to
provide in these areas.
A complete list of services provided in each area is available on our website
www.bridgewater.nhs.uk
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External
• Planning for patients
2014-2019
‘Everyone Counts’
• The regulatory framework –
Monitor, CQC, NTDA
requirements
• NHS outcomes framework
• Francis report
• Berwick report
• Cavendish review
• NHS Mandate 2013-2015
• Integration of health and
social care
Internal
• Maximising the
opportunities of Foundation
Trust status
• Local shift to community
provision
• Meeting the changing
demand and changing
demography
• Maximising the potential of
technology
• Maximising the opportunity
of being a Teaching Trust
• Integration and
co-ordination of care
DRIVERS FOR CHANGE
SHORT TERM
OBJECTIVES
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• Our workforce is fit
for purpose to
deliver our
redesigned services
and we have the right
staffing
arrangements to
deliver safe practice
• Our strategic
direction is built on
our track record of
successful delivery
supported by sound
information and
evidence
• We are financially
viable and sustainable with
effective systems
of intelligence and
control
• To be a well
regarded, credible
organisation with a
reputation for delivering responsive
and effective
community care
MEDIUM TERM
OBJECTIVES
• There will be a shift to
focus on community
health, self-care and
wellbeing
• The trust will have an
international profile
for its contribution to
tackling health
inequalities,
population wellbeing, and
delivering cost and
clinically effective
care
• The clinical workforce
will be rebalanced
to focus on our ‘care
offer’ maximising the
use of staff skills
• All patients with
defined long-term
conditions will
self-care, supported
by use of technology
LONGTERM
OBJECTIVES
• We are well-led: We
have effective
leadership and an
open, fair and
transparent culture
• We are responsive:
We ensure patients
get their treatment
and care at the right
time and that we
listen to them
• We are caring: We
treat people with
respect, compassion
and dignity
• Improved quality of
life for people with a
LTC
• We are effective: Our
care meets people’s
needs and results in
the best quality of life
• Our children are
healthy, school ready
and able to engage
with other children
• Prevent people from
dying prematurely
• Reduced unhealthy
lifestyles & behaviour
choices
• Our patients make a
productive
contribution to
society
• Increased proportion
of spend on services
outside hospital
• Improved life
expectancy in each
town year on year
STRATEGIC
OUTCOMES
• We are safe: We
protect people from
avoidable harm
QUALITY GOALS
Values: Patient Centre, Encouraging Innovation, Open and Honest, Professional, Locally Led, Efficient
• To deliver high
quality, safe and
effective care which
meets both
individual and
community needs
• Manage our relationships with
partners, stakeholders,
patients and the public to
ensure clarity of information,
promote joint working and
ensure continuity of care.
• Develop and implement the
objectives cascade and
• To deliver empower staff to provide care
which improves peoples’ lives
innovative and • Complete our ‘One
integrated care close
Bridgewater’ review
to home which programme and work with
supports and improves
patients and staff to design and
health, wellbeing and deliver effective and
independent living
responsive services
• Maximise the effectiveness
• To deliver value for
of IT and technology that is
available to staff, patients and
money, be financially
the public.
sustainable and be
•
Clearly identify the true costs
commercially
and price of our services
competitive
• Complete the development
of service line reporting and
• To achieve
management
Foundation Trust
• Deliver the requirements of the
status in 2014
regulatory frameworks
• Review our Integrated
Business Plan and discuss our
plans widely with key
stakeholders
OUR STRATEGIC
OBJECTIVES
MISSION:
To improve local health and promote well-being in the communities we serve.
Our 2014/15 Strategy on a page
Principal Risks
At the beginning of 2014/15, the Board has identified and monitors strategic areas of risk for
the organisation:
• A culture across all levels of the organisation that tolerates poor quality of service
quality and provision and fails to support and encourage staff
• Substandard quality of care and service delivery due to failure adhere to best
• Failure to adopt technology to improve quality and efficiency of healthcare
• Limited commercial competitiveness
• Financial/political initiatives affecting the health economy that influence increasing
demands without sufficiently matched income growth
• Failure to consistently deliver services that meet contractual obligations
• Failure to sustain and demonstrate long term financial viability
• Impact of the Cost Improvement Programmes including failure to deliver and impact
on quality of care
• Failure to maintain and improve sound systems of governance and effective internal
control
• Inconsistent data between similar services across Boroughs
• Failure to demonstrate benefits of organisational transition and structures
• Loss of income
• Failure to maintain financial viability
• Reputational damage
More detail on these risks and their likely impact is available within our Annual Governance
Statement.
Performance
This section highlights the Trust’s performance against strategic objectives. However, it is
important to note that as a part year report much of the performance data we use is
contained within our full year Quality Report for 2014/15.
The section below highlights progress against our strategic objectives during the reporting
period and also contains full year data for additional measures we are required to report on.
A separate section of the Strategic Report provides detail on our financial performance.
Progress against our Strategic Objectives 2014/15
During 2014/15 we had four strategic objectives, including one related to the achievement of
Foundation Trust status. During the five months from 1 November 2014 to 31 March 2015, we
made significant progress against each objective.
Strategic Objective: To deliver high quality, safe and effective care which meets both
individual and community needs
• We achieved the required progress against the majority of our Quality Improvement
Priorities for 2014/15 as evidenced in our Quality Report.
• We saw an increase in the percentage of patients expressing their overall satisfaction
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with their care and treatment, up to 99% in 2014/15 from 98% at the end of March
2014.
• In November we were delighted to be named winners of the 2014 Health Service
Journal (HSJ) Managing Long Term Conditions Award for the creation of our
Integrated Neighbourhood Teams in Wigan. The Teams have helped to create more
than 1,000 case management plans for high risk patients with long-term conditions
and contributed to a 43 per cent drop in visits to A&E and a 38 per cent fall in
emergency admissions. The Teams work alongside colleagues from Wigan Council,
Wrightington, Wigan and Leigh NHS Foundation Trust and Wigan Clinical
Commissioning Group.
• In December 2014 our Leigh Walk-in-Centre supported North West Ambulance
Service (NWAS) to prevent 88 attendances at Wigan Accident and Emergency
through participating in the NWAS Pathfinder Scheme. The centre provided advice
and an alternative destination for treatment to NWAS crews to help reduce winter
pressures in the local healthcare system in the Wigan borough.
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• Our community nursing teams in Halton and St Helens have also been working with
NWAS to develop and introduce individual community care plans for those patients
who frequently call emergency services in crisis situations. This aims to reduce the
likelihood of the patient being transported to hospital by giving the patient increased
confidence in managing their own care.
• In January 2015 we introduced a wider choice of treatment room clinics in Warrington
to enable patients to receive treatment more quickly and at a time and place that is
convenient for them.
• We worked with our partners in Warrington to look at how sharing data between health
and social care professionals affects care and if we can make any improvements.
• We began working in partnership with the School of Medicine and Dentistry at the
University of Central Lancashire to further develop our community placements for
undergraduate medical students.
• Details of other service developments during the year are available in the part year
annual report for Bridgewater Community Healthcare NHS Trust.
Strategic Objective: To deliver innovative and integrated care close to home which
supports and improves health, wellbeing and independent living
• In November we launched Florence simple telehealth technology within Orthopaedic
triage and Musculoskeletal physiotherapy services in Warrington. Patients receive a
series of texts to check if they are progressing as expected following injections. This
allows patients to respond at a convenient time and avoids the need for additional
appointments, thereby freeing up more appointment slots within the service.
• We introduced a text messaging reminder service for patients using our
Musculoskeletal Care and Treatment service to reduce the number of patients failing
to attend their appointments.
• Our inpatient unit at Newton Community Hospital has been working to support
patients who are assessed as being at high risk of a fall. Weekly audits have
demonstrated that 96% of patients are at high risk and a number of measures have
been introduced which have led to an overall reduction in the incidents of falls among
inpatients at the hospital.
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• In early 2014/15 we joined the #hellomynameis social media campaign by reminding
staff to go back to basics and provide a proper introduction when greeting patients
and to help to build trust between patients and staff.
• In March we launched a new Bridgewater web page for people with learning
disabilities. This dedicated interactive page has been designed to be compatible with
touch screen devices and contains a range of information in easy read format,
including details of learning disability services in each of our boroughs and local
support groups and charities for people with learning disabilities.
• We have been using a new Echo crowdsourcing tool to gain the views of staff on
different areas of our organisation. Staff have contributed ideas on areas including
administration support and children’s services. The Echo tool allows staff to submit
ideas, comment on them and vote for the best ones to take forward.
• From 1 January 2015 it became mandatory for all Bridgewater services to provide
patients with an opportunity to provide feedback on services via the national Friends
and Family questionnaire format. The test had been implemented in Bridgewater since
2013 and the questions are included in our standard “Talk to Us” patient feedback
form. During the reporting period, 12,896 people responded to the question. Details
are available in our Quality Report.
Strategic Objective: To deliver value for money, be financially sustainable and be
commercially competitive.
• At the end of the financial reporting period covered by this report we achieved our key
financial targets including generating a surplus of £0.154m for the part year
1 November 2014 to 31 March 2015 to fund contingencies. We ended the period with
a cash balance of £5.9m, sufficient to fund in excess of 10 days operating expenses.
At the end of the reporting period we achieved savings of £5.9 million as our
contribution to addressing the financial challenges in the health and social care
system in each of the areas we serve. Details of these savings are as follows:
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Clinical Services
Support Services
Non-Pay
Total
CIP 2014/15 £
2,834,574
825,420
2,244,648
5,904,642
• We successfully gained contracts to deliver:
• St Helen’s Paediatric Speech and Language contract
• Offender Health provision for Barton Moss Secure Children’s Home and St
Catherine’s Secure Children’s Home in partnership with Greater Manchester West
Mental Health NHS Foundation Trust
• Oral Surgery contract for Sandbach
• Community Dentistry working in partnership with Wirral Community NHS Trust
taking on the new area of Vale Royal which encompasses Winsford and Northwich
• A place on the Salford Public Health Services Procurement Framework
• A place on the National Childhood Influenza Immunisation Service Framework
• During the reporting period we retained contracts for the delivery of:
• Offender Health at Her Majesty’s Prison and Young Offenders Institute Hindley in
partnership with Greater Manchester West Mental Health NHS Foundation Trust
• Sexual Health Services in Warrington
• Homeless and Vulnerable Services in Wigan
• Infection Control services in Halton, St Helens and Warrington
• School Nursing in Halton
• Oral Surgery contracts for Cheshire West & Chester and Warrington
• In late 2014 we launched our Bridge Builder Community Trust Fund. This new charity
was set up to allow Bridgewater staff, patients and members to raise funds to make
a significant and positive difference to the lives of people in our local community.
Through fundraising activity and donations, ‘Bridge Builder’ will provide small grants
to voluntary and community groups, promoting and improving health and
wellbeing across Widnes, Runcorn, St Helens, Warrington and the Wigan Borough.
Bridge Builder’s Registered Charity Number is 1068887.
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Strategic Objective: To achieve Foundation Trust status in 2014
• On 1 November 2014 we achieved Foundation Trust status, becoming one of the first
two community trusts in the country to be awarded this licence.
• In November we held our inaugural formal meeting of the Foundation Trust Council of
Governors and continued to develop the role of our governors during the remainder of
the year. At our December Council of Governor meeting we focused on one of our first
priorities - to develop the role of Governors in spreading the message about our Trust
and our role to improve the health and wellbeing of our communities.
• In December we held a strategic planning exercise for our Service Managers and
Clinical Managers.
• Our Chief Executive, Dr Kate Fallon, who had led us from a community provider arm
of a Primary Care Trust to becoming one of the first community Foundation Trusts
retired at the end of March. The appointment of her successor Colin Scales,
previously Bridgewater’s Chief Operating Officer was announced just before the end
of the reporting period.
• During the week 23 to 27 March we held the latest of our successful Census Weeks to
ask patients what they thought of our services and to encourage patients to become
members of our Foundation Trust.
Our Quality Report in Appendix 4 contains more detail on specific service and quality
improvements which have been made throughout the year.
Short-term objectives
During the year we also set ourselves additional objectives to support the delivery of our
Strategic Objectives. Some of the key highlights are listed below:
Manage our relationships with partners, stakeholders, patients and the public to ensure
clarity of information, promote joint working and ensure continuity of care
Staff Health and Wellbeing
As at 31 March, Bridgewater employed 2784 WTE staff, the majority of whom are clinically
trained, including district nurses, health visitors, specialist nurses, occupational therapists,
speech and language therapists, physiotherapists and assistant practitioners.
The sickness absence rate for the Trust for this period was 5.40%. The latest data for
benchmarking purposes (December 2014) shows the average for community trusts is 8.5%.
The average rate for Trusts in the North West region is 5.4%.
The number of working days lost due to sickness absence was 18,209 and the average
number of working days lost per member of staff during this period was 12.
Measures taken to reduce the sickness absence rate during the period include improving
information provided to managers, including monthly absence reports.
24
In addition, an annual health and wellbeing week was held for staff in January which
attracted 128 staff to a market place at various sites across the Trust which provided health
checks plus advice on health improvement, occupational health services and counselling.
We continue to provide health and wellbeing support to all staff via counselling from
Wellbeing Partners and Insight (our Employee Assistance Programme).
Staff Survey
The Trust takes part in the national annual NHS staff survey which provides us with feedback
on how we are doing and how staff are feeling in relation to 29 key findings. The survey was
sent to a sample of 850 staff in October 2014 and 316 staff responded by the closing date.
This is a 38% response rate which is below the average for community trusts in England. This
is a lower response rate than the 2013 NHS Staff Survey results when 331 staff completed
the survey giving a 39% response rate.
Our overall staff engagement score was 3.67. This was an improvement on our 2013 staff
engagement score of 3.61 but is below the average of 3.75 for other community trusts.
Possible scores range from 1 to 5 with 1 indicating that staff are poorly engaged (with their
work, their team and their trust) and 5 indicating that staff are highly engaged.
Staff Survey Results
2013/14
Response rate
Trust
39%
Trust Improvement
/ Deterioration
2014/15
National Average
53%
Trust
38%
National Average
48%
10% deterioration
* Please note, the figures refer to the predecessor organisation prior to 1 November 2014
The five Key Findings for which Bridgewater Community Healthcare NHS Foundation Trust
compares most favourably with other community trusts in England
2013/14
Top five ranking scores
% of staff experiencing
physical violence from staff in
last 12 months
% of staff believing the trust
provides equal opportunities for
career progression or promotion
% of staff experiencing
harassment, bullying or abuse
from staff in the last 12 months
% of staff experiencing physical
violence from patients,
relatives or the public in the last
12 months
% of staff witnessing potentially
harmful errors, near misses or
incidents in the last month
Trust Improvement
/ Deterioration
2014/15
Trust
National
Average
Trust
National
Average
1%
1%
1%
1%
0% improvement
91%
91%
94%
91%
3% improvement
18%
20%
16%
19%
2% improvement
4%
9%
5%
8%
1% deterioration
20%
26%
20%
23%
0% improvement
25
The five key findings for which Bridgewater Community Healthcare NHS Foundation Trust
compares least favourably with other community trust in England
2013/14
Bottom five ranking scores
% of staff agreeing that their
role makes a difference to
patients
% of staff agreeing that
feedback from patients /
service users is used to make
informed decisions in their
directorate / department
% of staff having
well-structured appraisals in
last 12 months
% of staff reporting good
communications between
senior management and staff
% of staff agreeing that they
would feel secure raising
concerns about unsafe
clinical practice
2014/15
Trust Improvement
/ Deterioration
Trust
National Average
Trust
National Average
88%
91%
87%
90%
1% deterioration
-
-
41%
52%
No information from
previous year
35%
37%
32%
38%
3% deterioration
21%
29%
23%
33%
2% improvement
-
-
65%
72%
No information from
previous year
We acknowledge that there has been a slight deterioration in the overall response rate
however with the exception of the percentage of staff that have been appraised in the past 12
months there are no significant changes since the key finding since the 2013 survey, although
it needs to be noted that there are a number of key factors where the Trust score is either
below or average when compared to other community trusts.
Future priorities and targets
During the year, the Trust also introduced the Staff Friends and Family Test. More detail on
this test and the results is available in our Quality Report.
The results from both surveys need to be considered in the context of a period of significant
organisational change. The Trust is committed to taking the survey feedback on board to
ensure that our workforce is a healthy and motivated one. We will be developing a staff
survey action plan to address staff concerns and will continue to work with staff side and
staff in the development and achievement of the action plan. We are also currently running a
Listening into Action programme (LiA) to ensure that staff opinions are not just listened to, but
acted upon.
Employee Engagement
The key development during the year was signing up to Listening into Action (LiA) – a
national programme that will help us to engage and empower our clinicians and staff. In
addition to radically improving how engaged and valued our staff feel, LiA will support
managers to lead through engagement and give teams permission to make positive
changes. It will fundamentally change how we work.
26
The main work on this programme started in October 2014 with the launch of the LiA Pulse
Check to gain a benchmark of staff views and concerns.
In total, 1080 staff responded to the LiA Pulse Check in October and November 2014. The
key areas that were identified as mattering to staff included Leadership, Estates,
Communication, Staff Development, Staff Wellbeing, use of Agency Staff, Service Line
Management, SystmOne Patient Administration System, Morale, Recruitment, IT,
Procurement systems sharing ideas.
Following the initial Pulse Check a Trust-wide sponsor group was set up to lead a range of
projects to tackle the issues raised by staff. Within the first few months there have been a
number of quickly introduce benefits, including a centralised meeting room booking system,
Trust credit cards to support procurement, information on email etiquette and the provision of
mobile phones to staff who previously did not have access to them. Weekly sessions were
also launched to allow any member of staff to call in to see the Trust’s Director of People,
Planning and Development to ask questions or raise issues on an individual basis.
27
The Trust has a range of communications channels designed to keep staff informed and to
support two-way dialogue and engagement. These include a monthly Team Brief system led
by the Chief Executive. This contains key messages to keep staff informed on new
developments, changes to guidance and policy and performance (including HR performance
measures and financial performance). Staff also receive a fortnightly Bridgewater Bulletin
e-newsletter, have access to the Trust intranet and a monthly Chief Executive’s blog for staff
all of which are used to highlight progress against our strategic objectives. The Trust is also
active across a variety of social media channels.
As a Community Trust with a dispersed workforce, the Trust also uses text messaging to alert
staff to any urgent issues and to support emergency planning arrangements. Staff are also
encouraged to follow the Trust’s social media accounts on Twitter and Facebook. A new staff
voicemail for use in emergencies or bad weather was also introduced during the year to help
alert staff to advice and information.
Staff are also kept involved in the business of the Trust via a range of events, including those
with a focus on quality improvement and specific professional forums.
The Trust offers a full range of education and training courses and more detail on this is
included in our Quality Report 2014/15.
Celebrating our staff
We celebrate the achievements of our staff throughout the year through our “Stars of the
Month” scheme, which allows staff to celebrate the work of their colleagues throughout the
year and receive a certificate from the Chief Executive. During the year staff submitted 184
separate nominations for individual colleagues or teams as part of the scheme.
28
In October we introduced an Employee of the Month scheme to run in conjunction with our
Stars of the Month and build on its success.
The annual highlight of our reward and recognition is our Staff Awards ceremony, held in
March every year. This year the winners were presented with their trophies at an event at
Haydock Park Racecourse on 11 March. The winners were as follows:
Clinical Employee of The Year: Karen Anwyll – Community Nursery Nurse, based at
Castlefields Health Centre, Runcorn.
Outstanding Contribution to Innovation: Sarah Shone, Musculoskeletal Physiotherapist
based at Platt Bridge Health Centre, Wigan
Team of the Year: Children’s Community Nurse Team based at Woodview Child
Development Centre, Widnes
Non-Clinical Employee of the Year: Hazel Williams, Admin Officer, The Bridges Learning
Centre, Widnes
29
Patient Choice Award: Community Connection Point/Hospital Avoidance Nurses based at
Albion Street Clinic, St Helens
Employee of the Year: Alison Pearson, Highly Specialist Speech & Language Therapist
based at Warrington, chosen from all our Stars of the Month.
Chairman’s Award for Lifetime Achievement: John Ward, Retired Board Secretary
A number of our colleagues also received recognition throughout the year from external
bodies. They included:
•
•
•
•
•
•
Nicola Monaghan –invited to join the Institute of Health Visiting Fellowship Programme
Sarah Logan – Awarded Queen’s Nurse Title
Nicola Broad – Awarded Queen’s Nurse Title
Wigan Integrated Neighbourhood Team – won Health Service Journal Award for
Managing Long Term Conditions
Wigan Continence Care Service – Awarded Continence Care Team Award
Annette Dunning – John Moores University Award in recognition of her support to
another student
30
Equality, Diversity and Inclusion
Bridgewater’s mission ‘to improve local health and promote wellbeing in the communities we
serve’ can only be fulfilled if we recognise the diversity and differing, individual needs of the
people within these communities. Our Equality Statement demonstrates our commitment to
providing health care services and employment that is equitable and free from discrimination
and to upholding the values of dignity and respect for our staff and patients and their families
and carers.
Within the large population served by the Trust there are groups that suffer worse health,
poorer long term outcomes and shorter lives than the rest of the population. The Equality Act
provides for nine protected characteristic groups that are recognised as suffering inequality
when compared to the rest of the population. These protected characteristics are age,
disability, gender reassignment, marriage and civil partnership, pregnancy and maternity,
race, religion or belief, sex and sexual orientation. In addition, the Trust has recognised and
committed to improving health inclusion for other vulnerable groups within our population,
including those disadvantaged by lower socio-economic status, chaotic lifestyles (drug and
alcohol abuse), the homeless, destitute asylum seekers and refugees, sex workers and
carers.
In order to reduce health inequalities in our communities, the Trust must work to improve
inclusion in healthcare by understanding and removing the barriers to access. We aim to:
• Ensure that the services we provide are accessible to all
• Develop services which best meet the needs of our diverse communities
• Employ, develop and retain a workforce which at all levels reflects the diversity and
make-up of the population we serve
• Ensure that staff have information on equality, diversity and health inclusion
• Eliminate from our services, policies and decision making any adverse impact on the
promotion of equality or potential adverse effect on any particular groups or
communities
Health inequalities are a key feature of the framework within which all NHS organisations
operate. This includes the Health and Social Care Act 2012, the NHS Constitution, the NHS
Outcomes Framework and the Five Year Forward View.
The articles within the Human Rights Act 1998 have a big impact on healthcare, for example
the right to life, the right not to be tortured or treated in an inhuman or degrading way and the
right to respect for family and private life, home and correspondence. The FREDA (Fairness,
Respect, Equality, Dignity and Autonomy) principles of human rights are important in the
day-to-day work of all NHS trusts and this is reflected in two of the CQC essential standards
(person centred care and dignity and respect). These basic rights are also reflected within
the Trust’s values and are assessed and monitored through the equality analysis of services
and policies, through the Talk to Us patient survey and through patient complaints and
feedback.
The Trust operates its equality governance within the above frameworks and also within the
requirements of the Equality Act 2010 and in particular the general and specific duties of the
Public Sector Equality Duty. In order to demonstrate compliance with the duties the Trust
produces an annual Public Sector Equality Duty (PSED) Summary report and uses the
national NHS Equality Delivery System (EDS2) framework to assess and grade equality
31
performance for staff and patients. The information provided within the PSED and EDS2
is used, along with the information in the equality analysis of services and current national
equality and inclusion initiatives to produce Equality Objectives and an Equality and Health
Inequalities Action Plan that set out the plans for the coming years to improve equality
performance across the Trust.
All services have an equality analysis that seeks to identify barriers for service users whether
they be access barriers or assistance or attitude barriers. All service redesigns undergo an
equality analysis to assess potential impacts, positive or negative, on the protected
characteristic and vulnerable groups. Patient access is monitored through the PSED using
population information from the 2011 Census.
The Trust believes in equality of opportunity for all staff. Staff breakdown is monitored as part
of the annual PSED and from April 2015 we will be monitoring race/ethnicity in nine key
indicators set down in the NHS Workforce Race Equality Standard.
We regularly monitor the gender distribution among our workforce and as at 31 March our
figure our total workforce consisted of 2964 (91.5%) females and 274 (8.5%) males.
Our Board of Directors is composed of 3 (43%) female and 4 (57%) male directors and
among senior managers (band 8a to 8d) 28 (61%) were female and 18 (39%) are male.
As part of the PSED employee relations cases are monitored for any potential discrimination
issues, this includes dignity and respect and bullying and harassment. Within the last year
figures were too low to report, but no issues were identified in the analysis. The NHS Staff
Survey 2014 shows that 94% of staff believe the Trust provides equal opportunities for career
progression and promotion, which is above the national average for community trusts.
All staff undertake annual mandatory eLearning training, this includes a module on equality
and diversity and all new staff attending corporate induction receive the newly updated health
inclusion information. Compliance with these is monitored at Board level.
There is a suite of human resources policies in place to support, advise and protect staff,
these include Dignity and Respect at Work; Disciplinary; Grievance and Absence
Management policies. All policies undergo a review that includes checking by a member of
the health inequalities and inclusion team. Each policy has an equality impact assessment
that is reviewed during the bi-annual policy review and a member of the health inequalities
and inclusion team sits on the final policy approval group.
The Trust is committed to the Two Ticks, Age Positive, Mindful Employer and Personal Fair
Diverse Champions initiatives and this is reflected in job advertisements.
The Trust has no current or previous equal pay claims against it.
Existing and new staff with disabilities are supported in their work through the implementation
of reasonable adjustments recommended by Occupational Health and the Access to Work
scheme. Staff have access to occupational health and counselling services when required.
Reference is made to the particular needs of employees with disabilities in the Absence
Management; Dignity and Respect at Work and Recruitment policies.
32
The health inequalities and inclusion team are planning to focus on barriers to access for our
patients in the coming year. This will mean work on several fronts, including the following:
•
•
•
•
•
•
•
Signing of British Deaf Association British Sign Language Charter
Production of reasonable adjustments guidance for Trust staff
Production of religion and belief guidance for staff
A rolling programme of access audits of Trust services
Review of language interpretation and translation provision
Awareness raising through the Personal Fair Diverse Trust Champions
Submission to Stonewall Workplace Equality Index
Detailed Trust equality information such as our Equality Statement, the Public Sector Equality
Duty reports, our EDS (and EDS2) grading results and service equality analysis are published
on our website www.bridgewater.nhs.uk.
Engagement and Consultation with patients
A key element of our engagement with our patients is through our Patient Partners
programme. More than 190 Patient Partners are signed up with the Trust and are actively
working with services to identify and implement service improvements.
The Trust also uses a range of methods to seek patient feedback including the use of patient
stories, and patient surveys using our “Talk to Us” form which includes the Friends and
Family Test questions. More detail on this work is available in our Quality Report
(Appendix 4).
There were no formal public consultations during the period 1 November 2014 to 31 March
2015.
33
Patient Advice and handling of complaints
We recognise that when people have issues or concerns we should aim to resolve these as
soon as possible. Our Patient Services function helps patients, carers and families resolve
any issues and concerns.
Bridgewater is committed to the Ombudsman’s Principles for Remedy in its complaints
handling procedure. This ensures that when handling complaints we are getting it right,
being customer focused, being open and accountable, acting fairly and proportionately,
putting things right and seeking continuous improvement.
More detail on our approach is contained within our Policy and Procedure for the Handling of
Compliments, Comments, Concerns and Complaints which is available on our website
www.bridgewater.nhs.uk.
More detail on the number and nature of patient enquiries and complaints received during
the year 2014/15 is available in our Quality Report.
Working in partnership
Each of the boroughs where we provide the majority of community services has an Executive
Director or General Manager link with the Clinical Commissioning Group, local authority and
other health service providers.
The Director of Corporate Development also has links with local Healthwatch organisations
in each borough as well as the third sector, local charitable organisations and patient groups.
Our meetings with local Healthwatch are used to discuss and highlight any local social and
community issues. We also support their work to consult about our services. During the year
34
no social or community issues which would have a specific impact on our business were
identified through these forums.
We also have representation on the Health and Wellbeing Boards in each borough and are
members of the local partnership boards, where they exist.
Details on a range of partnership working projects are contained within our Quality Report.
Working in the community
As a community trust we aim to make a significant positive difference to the health and
wellbeing of local people, not just through the quality of the services we provide but by being
a good corporate citizen.
An exciting development during the year was the establishment of the Bridge Builder
Community Trust Fund which aims to fund local good causes to improve the health and
wellbeing of people living in our local communities.
The fund will build our relationship and partnership with our communities by being open to
community groups, voluntary and other not for profit organisations with charitable objectives
based in the boroughs served by Bridgewater. Grants will be available for projects which
could range from allotments and gardening clubs to holiday clubs and playgroups. A panel
consisting of staff and governors has been set up to consider all applications. The first grants
will be awarded early in the 2015/16 financial year.
Develop and implement the objectives cascade and empower staff to provide care
which improves peoples’ lives
A plan to revise our staff Performance Development Review process was introduced with
the objective of creating an improved staff appraisal tool which links more clearly to the Trust
objectives.
35
All corporate functions completed an Annual Business Planning process which was based
on individual business plans for corporate directorates. These contained department specific
objectives with a clear link to the Trust Strategic Objectives.
Complete our ‘One Bridgewater’ review programme and work with patients and staff
to design and deliver effective and responsive services
During the period 1 November 2014 to 31 March 2015 we completed the implementation of
our new One Bridgewater clinical structures. Services were organised into three clinical
directorates: Adults Services, Children and Families’ Services and Specialised Services. This
will support the creation of a Bridgewater standard of service and lead to better sharing of
good practice across the Trust. General Managers were appointed to the three directorates
and appointments were made to Service Manager and Clinical Manager posts.
Maximise the effectiveness of IT and technology that is available to staff, patients
and the public.
We launched a mobile Electronic Patient Record app to support our Patient Administration
System, known as SystmOne. A launch event explained the benefits of the SystmOne mobile
app to help staff update and access information on the go and to support mobile working to
become embedded in the trust.
Our Listening into Action programme has delivered a number of quick benefits for staff and
patients since its launch in October. These included access to teleconferencing tools for all
Trust staff. This will help to reduce unnecessary time spent travelling and reduce mileage
claims by providing an alternative to face-to-face meetings where staff are based across
different buildings and boroughs. It will also contribute to our environmental and
sustainability objectives. Listening into Action also expedited other actions including the
introduction of a number of Trust credit cards to support the procurement of goods and
services via the intranet, to further support efficiencies. Another welcome development was
the provision of free Wi-Fi at Newton Community Hospital for patients and visitors.
During early 2015 we piloted a new intranet platform with some staff as part of our
commitment to development of a new state-of-the-art intranet. This will improve the
availability of information through an improved document library and search facility, saving
staff time. The intranet has been developed with help from a small staff group who have
provided feedback and suggestions during every stage of its development.
Clearly identify the true costs and price of our services and complete the
development of service line reporting and management
Our Service Line Reporting and Service Line Management processes and information
continue to provide financial, workforce and operational activity data to managers and budget
holders working in frontline healthcare services as well as staff in corporate functions. This
information is increasingly being used to help us understand the cost of operating our
services.
A realistic assessment of cost and price is a key part of any bids we submit to win new
business or retain existing business. This will be an ongoing priority for the Trust during
2015/16.
36
Deliver the requirements of the regulatory frameworks
During our first 5 months of operation as a Foundation Trust, we have declared and had
verified the following risk ratings in line with the Monitor Risk Assessment Framework.
Table of Analysis - Monitor risk ratings
2014/15
Continuity of service rating
Governance rating
Q1
n/a
n/a
Q2
n/a
n/a
Q3
4
Green
Q4
4
Green
The Trust is required to register with the Care Quality Commission (CQC) and throughout the
period, the Trust has continued to declare full compliance with the essential standards and
remains registered, without conditions.
Our Quality Report contains more details of the CCGs inspection and assessment of our
Trust and services.
Health and Safety
Bridgewater has clear, consistent policies that set out the Trust’s commitment to complying
with the statutory and mandatory requirements for Health and Safety, Fire Safety, Violence
and Aggression, and Security.
Specific strategies aligned to the Trust’s mission and its Risk Management Strategy set the
long-term direction for Health and Safety and Fire Safety management and performance.
These strategies assist the Trust in protecting its employees and all others from the risks
arising from its work activities, and there are six principal objectives intended to ensure the
Trust is an organisation where there is: strong leadership for safety, a resilient safety
management system, coherence of policies and procedures, compliance, competency and
capability all set within a cycle of continuous improvement.
The Trust has engaged competent contractors to carry out compliance surveys across its
premises for the management of asbestos, water hygiene, electrical and gas services,
pressure vessels, medical gas systems, building structures and fire protection. Findings of
these surveys, together with existing risk assessments, have been used to produce risk
profiles for the estate so that informed decisions can be made about future improvements.
Management of Risk
The Trust uses the web-based Ulysses Safeguarding Risk Management system for reporting
strategic risks, operational risks and incidents.
During the year, following feedback from both Monitor and the CQC we prioritised the
reporting and management of risk, with focused training for staff to address weaknesses in
our systems. During the year there was an increase in risk reporting, which is viewed as a
positive indication of an open and honest culture which encourages staff to report incidents
so they may be investigated to learn lessons.
37
Further details on significant operational risks and serious untoward incidents are in the
Annual Governance Statement whilst details on aspects of Patient Safety are in our Quality
Report in Appendix 4.
Information Governance
Security of patient and staff information is considered to be of paramount importance to the
Trust. More detail on assessments of our systems, standards and processes for managing
information is available in our Quality Report 2014/15.
Bridgewater does not routinely charge for information produced by the Trust. However, the
Trust does set charges for information under The Freedom of Information and Data Protection
(Appropriate Limit and Fees) Regulations 2004 which may apply for some requests.
Therefore we can confirm that we comply with Department of Health and Treasury guidance
for information requests.
Details of any serious incidents involving data loss or confidentiality breach are contained
within the Annual Governance Statement within this report.
Emergency Preparedness, Resilience and Response (EPRR)
As a provider of NHS-funded healthcare, the Trust has defined roles and responsibilities
under the Civil Contingencies Act 2004, the Health & Social Care Act 2012, NHS England
Emergency Planning Framework 2013, NHS England Core Standards for EPRR 2014 and
other associated guidance.
All NHS-funded organisations must identify a Board-level Accountable Emergency Officer
(AEO) who is responsible for ensuring they comply with legal and policy EPRR requirements.
The Trust’s AEO is the Chief Operating Officer, who is supported in discharging these duties
by the Head of EPRR.
We have an Emergency Planning Steering Group to coordinate and oversee the EPRR
function and ensure that we have major incident, business continuity and other emergency
plans which are regularly reviewed and tested. This group also monitors the action plans we
have in place to address any areas for development which have been identified.
Planning for emergencies cannot be undertaken in isolation, so we work closely with the
wider health economies in the areas we serve and take part in joint training and exercising
opportunities. We are represented on the Greater Manchester, Cheshire and Merseyside
Local Health Resilience Partnerships, each of which provides a strategic forum for joint
planning for emergencies.
Some of the work covered during this reporting period for 2014/15 is highlighted below.
In November 2014 we submitted a declaration of full compliance to NHS England following
our self-assessment against the Core Standards for EPRR.
Mersey Internal Audit Agency carried out a review of EPRR systems and procedures in the
Trust and reported a rating of significant assurance to the Trust’s Audit Committee in
December 2014.
38
Our major incident plan is a live document which is regularly updated to take account of any
national or local changes. The latest version was presented to the Board for approval with
the annual EPRR report in December 2014.
A key priority for 2015-16 is the implementation of revised on call arrangements, including a
programme of training for rota members and other relevant staff.
Environmental management and sustainability:
The core focus of the Trust’s work since its inception has been the consolidation of its
accreditation to international Environmental Management System ISO 14001. Bridgewater
is one of a handful of community healthcare trusts to have achieved this status and it takes
the Trust well beyond the best practice requirements set out for the NHS. The Environmental
Management System (EMS) focuses on four key themes, which form the basis of the EMS
action plan: Energy Use in Buildings, Travel and Transport, Procurement and Waste. The
EMS provides a framework, which helps to ensure that the Trust quantifies, monitors and
reviews performance in all of these key areas.
Goal 1: A healthier environment
A healthier environment can contribute to better outcomes for all. This involves valuing and
enhancing our natural resources, whilst also reducing harmful pollution and significantly
reducing carbon emissions. Bridgewater has an overall carbon reduction target of 28% by
2020 (from 2013/14 baseline).
Goal 2: Communities and services that are ready and resilient for changing times and
climates
When periods of heat, cold, flooding and other extreme events occur it is vulnerable people
and communities that suffer the worst. Bridgewater will be part of multi-agency planning and
organisational collaboration to provide a better solution to these events
Goal 3: Every opportunity contributes to healthy lives, healthy communities and healthy
environments:
Bridgewater will take every opportunity to support communities and people to be
independent and self-manage conditions and events.
Success will only be achieved if Bridgewater as a whole takes positive action, if the Trust
engages widely with staff, members and patients and if sustainability is embedded into
the decision-making processes at every level. To achieve this aim the Trust has drafted an
Environment Strategy to help Bridgewater and the communities it serves to become greener
more resilient. The strategy will be published later in 2015.
2014/15 Environmental Performance
From the information currently available the Trust’s (and its predecessor organisation) overall
carbon footprint for 2014/15 (on a ‘like for like’ basis) is 11,739 tCO2e, equating to 5.6kg of
CO2e per patient contact. This is an increase in the overall footprint of 4.5% since 2013/14.
The figures in this report reflect full year figures as seasonal variations in energy usage would
distort any part year results.
39
Overall change in Carbon Footprint
14,000
Organisation Carbon Footprint using HM Treasury
Scope Aggregations
Carbon Emissions (tco2e)
12,000
HM Treasury Scope 1
HM Treasury Scope 2
10,000
HM Treasury Scope 3
8,000
6,000
4,000
2,000
0
The increase is mainly the result of shifts in energy use in buildings, increases in UK
Government carbon intensity figures and increased miles travelled by employees in their own
cars in the delivery of services.
Breakdown of Carbon Footprint according to Scope categories used by the Treasury
Sustainability Development Unit
Carbon Emissions (tco2e)
Carbon Footprint using the SDU model and
Treasury Scopes 2014/15
2,500
2,000
1,500
1,000
Scope 1 - Direct
Scope 2 - Indirect
40
Scope 3 - Indirect
Pharmaceuticals
Travel
Commissioning
Energy Well to..
Other..
Other..
Paper Products
Food and..
Freight Transport
Information..
Manufactured..
Busines Services
Capital Spend
Construction
Wast and Water
0
Gas
Oil
Coal
Owned Vehicles..
Leased Assets..
Anaesthetic..
Electricity
Imported
500
Energy, Travel, Procurment and Waste as a proportion of Carbon Footprint
Proportions of Carbon Footprint
15%
Energy 2
Travel
20%
Procurment and Waste
65%
Please note that this graph represents only those elements that can be currently quantified.
The figures use the CO2e conversion factors provided by the Sustainability Development Unit
in the Sustainability Reporting Framework 2014/15, these may vary from other factors used
by the Trust in previous years.
Carbon Emissions breakdown
Full Year 2014/15
Energy*
Procurement
Transport
Waste
Carbon Emissions (tC02)
1771
7639
1289
-
Units measured
4.1 million kWh
Non pay spend £22.5m
5.6 million kilometres
388 tonnes
*Initial analysis suggests the rise in tC02 is due in part to the change in the amount of C02
the government calculates it takes to produce and distribute a KWh of electricity and in part
due to a decrease in gas use that has been offset by an increase in electricity use.
Energy Use in Buildings: overall there has been a 16% decrease in the number of kWh of
energy Bridgewater used in its buildings to deliver health services for both electricity and gas
combined falling from 4.8 million kWh in 2013/14 to 4.1 million kWh in 2014/15.
However, despite this reduction there has been a 11% increase in the tCO2e between
2013/14 and 2014/15 rising from 1,593 to 1,771 tCO2e. Initial analysis suggests that this rise
is due in part to the change in the amount of CO2e the government calculates it takes to
produce and distribute a kWh of electricity (which has increased by 11% since 2013/14) and
41
in part to a decrease in gas use that has been offset by an increase in electricity use. The
latter being more carbon intensive than the former.
Procurement: Using the information currently available the Trust’s carbon footprint from the
procurement of goods and services is 7,639 tCO2e. The figures clearly show that
procurement is by far the largest part of the Trust’s carbon footprint. The breakdown of the
procurement data provides us with an indication of the carbon hotspots for procurement,
which includes businesses services, pharmaceuticals and medical equipment and
instruments. The Trust is planning to work on this area in the coming year.
Transport: It is calculated that employees travelled approximately 5.6 million km in their own
vehicles in the delivery of community health services during 2014/15, which resulted in 1,289
tCO2e. This is a 35% increase in miles travelled and emissions and further work will need
to be undertaken to understand the factors contributing to this, including if it can in part be
attributed to changes in the data collection methodologies.
Waste: It is calculated that the Trust produced 388 tonnes of waste during the last 12
months. Of this 346 tonnes can be described as general or domestic waste. The Trust
recycled or recovered 80% of this domestic waste through external contractors. In addition
the Trust produced a further 42 tonnes of clinical waste almost all of which was used to
produce energy from waste or was processed to produce solid recovered fuel which is used
in place of fossil fuels in the manufacture of cement. The Trust will continue to look for ways
to recyle more of our waste but the core aim will always be to reduce the amount of waste
produced.
Success will only be achieved if Bridgewater as a whole takes positive action, if the Trust
engages widely with staff, members and patients and if sustainability is embedded into
the decision-making processes at every level. To achieve this aim the Trust has drafted an
Environment Strategy to help Bridgewater and the communities it serves to become greener
more resilient. The strategy will be published later in 2015.
In 2015 Bridgewater will also be rolling out a series of engagement events called ‘Healthy
Environment, Healthy You’ to provide information and advice to staff and patients alike, about
the way slight changes in our daily activities can have a huge impact on our own health and
the health of the environment. This will be followed up with further activities aimed at each of
the four EMS themes.
Anti-Fraud Measures
All NHS organisations in England and Wales have an appointed Anti-Fraud Specialist. The
Audit Committee oversees a programme of counter fraud arrangements, including a contract
with Mersey Internal Audit Agency for a local Anti-Fraud Specialist.
Bridgewater works with its specialist to protect staff and resources from fraudulent activities
and all NHS employees have responsibilities when it comes to reporting suspicions or
concerns relating to fraud, bribery or corruption.
Staff are regularly surveyed to help establish awareness levels of fraud within the NHS and
staff are made aware of antifraud measures through the corporate induction and staff
awareness sessions. Information on policies and guidance relating to fraud, including the
Whistleblowing policy, is available on the Trust intranet for staff.
42
Additional Disclosures
Pension Liabilities
Past and present employees are covered by the provisions of the NHS Pensions Scheme.
Details of the benefits payable under these provisions can be found on the NHS Pensions
website at www.nhsbsa.nhs.uk/pensions. The scheme is an unfunded, defined benefit
scheme that covers NHS employers, GP practices and other bodies, allowed under the
direction of the Secretary of State, in England and Wales. The scheme is not designed to be
run in a way that would enable NHS bodies to identify their share of the underlying scheme
assets and liabilities. Therefore, the scheme is accounted for as if it were a defined
contribution scheme: the cost to the NHS Body of participating in the scheme is taken as
equal to the contributions payable to the scheme for the accounting period. A fuller
explanation with regard to pension liabilities is included in the statutory accounts.
Financial Performance for 2014/15
Introduction
The Trust’s accounts have been prepared under a direction issued by Monitor under the
National Health Service Act 2006.
For the financial reporting period 1st November 2014 to 31st March 2015, Bridgewater
Community Foundation NHS Trust has reported a small surplus of £0.154m this is the same
figure as in the summarisation schedules that underpin the accounts.
The Trust had initially proposed an adjustment to the 2014/15 accounts amounting to £2.6m.
This represents the capital value of all wheelchair and other community loan assets owned
by the Trust, which have been purchased over a number of accounting periods. However, the
new accounting treatment in respect of such items will only apply to the FT accounts.
Therefore, only those costs incurred by the Trust in the five months from 1st November to
31st March 2015 may be properly capitalised.
Unfortunately, due to a variety of issues, the Trust did not meet the filing deadline of the 29th
May 2015 for Monitor.
A review of the circumstances and contributory issues in relation to the missed deadline is
being undertaken by the Trust together with an external review of the Trusts processes.
Accounting Policies
The accounts have been prepared to comply with International Financial Reporting
Standards (IFRS) as modified by the Department of Health Manual For Accounts.
Capital Expenditure
The Trust’s incurred £2.5m of capital expenditure in the accounting period. Of this £1.6m was
expended on IT assets, £0.7m on medical equipment and £0.2m on building assets.
Treasury Policies and Cash
The Trust had an end of year cash target of £4.1m. Actual cash was £5.9m supporting the
requirement to achieve ’10 days of forward operating expenses’. The Trust did not have any
requirements for short-term loans during 2014/15 nor placed any funds for investment
purposes during 2014/15.
43
Income
The Trust generated income in the accounting period of £63.1m. Income derived from
Clinical Commissioning Groups (CCGs) and NHS England was £53.4m. The vast majority of
the Trust’s healthcare income is through ‘block service level agreements’.
The balance of the Trust’s income was generated as shown in the chart below. This highlights
the categorisation of all the Trust’s income taken from the accounts.
Sources of Income 2014/15 M8-M12
CCGs and NHS England £53.4M (84.7%)
NHS Trusts £0.2M (0.3%)
Foundation Trusts £0.2M (0.2%)
Local Authorities £6.8M (10.7%)
NHS Injury Scheme £0.3M (0.5%)
NHS Other £0.5M (0.8%)
Education and Training £1M (1.6%)
Other £0.8M (1.2%)
Expenditure
The Trust’s main source of expenditure is Employee Costs (staff) totalling £43.5m,
representing 69% of total expenditure. The chart below highlights the breakdown of these
costs.
Employee Costs 2014/15 M8-M12
Medical & Dental staff £3.7M (8.5%)
Qualified Nursing and Health Visiting staff £20.4M (46.9%)
Scientific, Therapeutic and Technical Staff £7.4M (16.9%)
Healthcare assistants and other support staff £2.9M(6.6%)
Administration and estates £9.1M (20.8%)
Others £0.1M (0.2%)
44
Expenditure on Operating Expenses, excluding employee costs, amounted to £19.2m. The
chart below provides an analysis of this expenditure by category.
Operating Expenses 2014/15 M8-M12
Services from Other NHS Organisations £3.3M (17.4%)
Supplies and Services - Clinical £4.1M (21.5%)
Supplies and Services - General £1.3M (6.9%)
Establishment £1M (5.2%)
Transpost £1M (5.1%)
Legal Fees £0.1M (.7%)
Consultancy costs £0.3M (1.6%)
Premises £1.9M (9.8%)
Rental under operating leases - minimum lease payments £5M (25.8%)
Education and Training £0.1M (0.7%)
Other £1M (5.3%)
Events After the Reporting Period
There were no events after the reporting period.
Going Concern
The financial statements have been prepared on a going concern basis. The Board receives
monthly reports regarding the financial position of the Trust and updates on any key financial
issues impacting the going concern basis for preparation of the financial statements.
Additionally, as part of the annual planning cycle the Board reviews and approves the Trust’s
five year financial plan. A detailed financial plan for 2015/16 has been presented to and
reviewed by Monitor, the Trust’s financial regulator and no concerns have been raised as to
financial sustainability.
The financial plan submitted shows a Continuity of Service Risk Rating of four. This planned
rating is consistent with a rating of four actually achieved for 2014/15. This is the maximum
rating achievable and provides assurance that the Trust has the liquidity to cover its operating
expenses and is generating sufficient surplus to cover dividend payments.
The annual contracting round has been completed and the Trust is assured by signed
contracts in relation to the majority of its forecast healthcare income.
The submitted financial plan for the two years includes a significant Cost Improvement
Programme (CIP) of £6.6m for 2015/16 delivery of which is essential in order to achieve the
45
forecast financial position. Plans to deliver this CIP are part of a five year CIP plan based on a
clinically led re-design programme which commenced in 2013/14.
Clinical Reference Groups (CRGs) lead each project (clinical services are grouped into three
phases, each containing multiple services). Each service is supported by a project manager
and clinical lead and is sponsored by an Executive Director.
Monitoring delivery is via the fortnightly CIP Programme Team (includes general managers,
finance, HR, estates, information, service improvement, staff side and clinical governance).
Monthly, there is a report presented to the Trust’s Finance Committee , a Board
sub-committee chaired by a Non- Executive Director. Quality Impact Assessment (QIA) is
reported to both the CIP Programme Team and Finance Committee in order to provide
assurance that whilst the programme is on track from a financial perspective there is no
compromise to quality or patient safety.
Future Financial Performance
The Trust faces a number of challenges over the next few years:
• Ensure expenditure levels are controlled in line with contractual income assumptions.
• The Trust has significant Cost Improvement Programme (CIP) targets detailed above
for 2015/16 and beyond. This will require the Trust to continue to review all services
to ensure that each service is performing efficiently whilst ensuring that the quality of
service is not affected.
46
External
• Planning for patients
2014-2019
‘Everyone Counts’
• The regulatory framework –
Monitor, CQC,
• NHS outcomes framework
• External reviews including
Francis, Berwick, Saville and
Cavendish reports
• 5 year forward plan
• New models for integrated
health and social care
• Freedom to speak Up
Internal
• Maximising the
opportunities of Foundation
Trust status
• Local demand for a shift to
community provision
• Meeting the changing
demand and changing
demography
• Maximising the potential of
technology
• Listening into Action and
culture development
DRIVERS FOR CHANGE
• Manage our relationships with
partners, stakeholders, patients
and the public to ensure clarity of
information, promote joint working
and ensure high quality
integrated, evidence based, safe
and patient-centered care.
• Develop and implement the
objectives cascade and
empower staff to provide care which
improves peoples’ lives promoting
the outcomes from Listening into
Action, reducing bureaucracy and
empowering staff to find solutions.
• Maximise the effectiveness of IT and
technology that is available to staff,
patients and the public.
• Clearly identify the true costs and
price of our services
• Deliver the requirements of the
regulatory frameworks
• Clarify and promote the values and
behaviours expected within
Bridgewater.
• Ensure that the Trust maximises the
opportunities afforded through the 5
year forward plan.
SHORT TERM
OBJECTIVES
• The Trust will have an
international profile for its
contribution to tackling
health inequalities,
population wellbeing,
and delivering cost and
clinically effective care
• There will be a shift to
focus on community
health, self-care and
wellbeing
• The clinical workforce will
be rebalanced to focus on
our ‘care offer’
maximising the use of staff
skills and supported by
highly trained and
responsive support
services
• All patients with
defined long-term
conditions will be able to
self-care, supported by
use of technology
MEDIUM TERM
OBJECTIVES
• We are well-led: We
have effective
leadership and an
open, fair and
transparent culture
• We are responsive: We
ensure patients get
their treatment and care
at the right time and
that we listen to them
• We are caring: We treat
people with respect,
compassion and
dignity
• Improved quality of life
for people with a LTC
• We are effective: Our
care meets people’s
needs and results in
the best quality of life
• Our children are
healthy, school ready
and able to engage with
other children
• Prevent people from
dying prematurely
• Reduced unhealthy
lifestyles & behaviour
choices
• Our patients make a
productive contribution
to society
• Increased proportion
of spend on services
outside hospital
• Improved life
expectancy in each
town year on year
STRATEGIC
OUTCOMES
• We are safe: We protect
people from avoidable
harm
QUALITY GOALS
Values: Patient Centre, Encouraging Innovation, Open and Honest, Professional, Locally Led, Efficient
• To deliver value for
money, be financially
sustainable and be
commercially
competitive
• To deliver innovative and integrated care close to
home which supports and improves
health, wellbeing and independent living
• To deliver high
quality, safe and effective
care which meets both
individual and
community needs
OUR STRATEGIC
OBJECTIVES
2015/16 MISSION:
To improve local health and promote well-being in the communities we serve.
Our Strategy for 2015/16
47
Our priorities for 2015/16
In order to achieve our strategic objectives we will focus on the following short term
objectives for 2015/16 and these will inform our business planning process.
• Manage our relationships with partners, stakeholders, patients and the public to
ensure clarity of information, promote joint working and ensure high quality,
integrated, evidence based, safe and patient-centred care.
• Develop and implement the objectives cascade and empower staff to provide care
which improves peoples’ lives promoting the outcomes from Listening into Action,
reducing bureaucracy and empowering staff to find solutions.
• Maximize the effectiveness of IT and technology that is available to staff, patients and
the public.
• We will maximise the effectiveness of IT and technology used within the trust that is
available to staff, patients and the public.
• Clearly identify the true costs and price of our services.
• Deliver the requirements of the regulatory frameworks.
• Clarify and promote the values and behaviours expected within Bridgewater.
• Ensure that the Trust maximises the opportunities afforded through the five year
forward plan.
48
Our Integrated Business Plan (IBP) outlines our plans to develop our services, our workforce
and focus on quality over the next five years. The plan also ensures that we can operate as a
financially sustainable Foundation Trust.
After making enquiries, the directors have a reasonable expectation that the NHS Foundation
Trust has adequate resources to continue in operational existence for the foreseeable future.
For this reason, they continue to adopt the going concern basis in preparing the accounts.
The Strategic Report for Bridgewater Community Healthcare NHS Trust was approved on
behalf of the Board on 26 May 2015.
Accounting Officer Colin Scales (Chief Executive)
June 2015
49
4. Directors’ Report
Directors’ statement
As directors, we take responsibility for the preparation of the Annual Report and Accounts.
We consider the annual report and accounts, taken as a whole, to be fair, balanced and
understandable and provide the information necessary for patients, regulators and other
stakeholders to assess the Trust’s performance, business model and strategy.
The Board of Directors
Bridgwater Community Healthcare NHS Foundation Trust was authorised and awarded its
Foundation Trust Licence by the independent regulator Monitor on 1 November 2014.
The Trust Board has overall responsibility for leading and setting the strategic direction for
the organisation. It is also takes a lead in holding the Trust to account for the delivery of the
strategy, through monitoring performance and seeking assurance that systems of control
are robust and reliable. This includes ensuring the delivery of effective financial control, high
standards of clinical and corporate governance and promoting partnership working in the
communities we serve. The Board is also responsible for shaping the culture of the
organisation.
The Board consists of both Executive and Non-Executive Directors. We consider each
Non-Executive Director to be independent. The length of each Non-Executive Director
appointment is detailed in the biographies below.
The directors of the Bridgewater Community Healthcare NHS Trust for the period
1 November 2014 to the 31 March 2015 were as follows:
Harry Holden – Chairman
Harry was confirmed in the post of Chairman of the Trust in November 2010 when the Trust
was established as a statutory body and was re-appointed as Chair on 1 April 2013.
Prior to this he chaired the Board of Ashton, Leigh and Wigan Community Healthcare - the
provider arm of NHS Ashton, Leigh and Wigan Primary Care Trust (PCT) and previously held
roles on the board of the PCT, including the position of Vice-Chair.
During his career Harry served as a Chief Officer and member of the Cabinet at Wigan
Council, holding the post of Director of Land and Property and Community Safety for 15
years. This role led him to becoming Chairman of the Community Safety Partnership Joint
Commissioning Group. In these roles Harry provided strong leadership and worked with
partners at all levels to develop a range of successful projects and organisations. Harry’s
current term of office is until 1 November 2015.
Harry also chairs the Nominations and Remuneration Committee.
Qualifications
Member Association of Building Engineers (M.B.Eng)
Fellow Chartered Association of Building (F.C.I.O.B)
50
Dr Kate Fallon – Chief Executive
Kate was appointed to the post of Chief Executive when the Trust was established in
November 2010. Kate qualified as a doctor in 1978 and practised as a GP in Wigan for
more than 20 years.
In 1997 Kate became a part-time Clinical Director at the local hospital group in Wigan, where
she helped establish a range of innovative care pathways for patients with conditions such as
diabetes, lung problems and cancer. When the Primary Care Trust (PCT) was established in
Wigan in 2002 she was appointed Medical Director, responsible for maintaining professional
standards in high quality care. In 2004 she left GP practice to focus full-time on developing
community health services in the town, initially as Managing Director of Ashton, Leigh and
Wigan Community Healthcare – a predecessor to Bridgewater Community Healthcare NHS
Trust.
During this time Kate has represented community health providers on a range of national
forums including the Department of Health Transforming Community Services Programme
and the national Community Foundation Trust pilot.
Qualifications
1975 MA – First-Class Honours in Physiological Sciences, Oxford University.
1978 MB BS – University of Newcastle.
GMC Registration: 2431240.
Karen Bliss – Non-Executive Director
Karen qualified as a Chartered Accountant in 1991 after joining PricewaterhouseCoopers as
a graduate trainee. She has held a variety of roles within the company at senior management
level and has worked in audit, business assurance and due diligence.
She was originally appointed to the Board of Ashton, Leigh and Wigan Community
Healthcare in 2008 and appointed to the Board of Bridgewater in 2010. She was most
recently appointed on 1 April 2013 for a term of office until 31 March 2017.
Karen holds the position of Chair of Audit Committee within the Trust.
Qualifications
BA (Hons) Engineering, Cambridge University
Fellow of The Institute of Chartered Accountants (FCA)
Steve Cash – Non-Executive Director
Steve has held a number of senior roles in commercial management, strategic partnership
and financial management spanning 30 years and currently holds a senior leadership
position within the FTSE 100 company BT. He has broad leadership and business skills
including strategy, finance, marketing, partnering and operational management.
He was originally appointed to the Board of Ashton, Leigh and Wigan Community Healthcare
in 2008 and appointed to the Board of Bridgewater in 2010. He was most recently appointed
on 1 April 2013 for a term of office until 31 March 2017.
Steve also holds the position of Chair of the Finance Committee.
51
Qualifications
Global Partner Vision programme – Harvard and Beijing University
Diploma in Marketing – Manchester University
BA Business Studies – University of Central Lancashire
Dorothy Keates - Interim Executive Nurse/ Director of Governance
Dorothy qualified as a State Registered Nurse in 1981 at Broadgreen Hospital and has
worked for more than 35 years within the NHS. An experienced clinician she has worked in
midwifery, as a district nursing sister and has undertaken a teaching qualification leading to
her developing one of the first training courses for practice nurses. With a passion for
nursing in community and primary care settings, she has undertaken managerial and
leadership training to support her role as an NHS leader and has specialised in clinical
governance and the implementation of quality initiatives across a number of organisations.
She is passionate about delivering quality care for every patient and supporting staff to deliver
a positive patient experience.
Dorothy joined the Board on 1 September 2014 on an interim basis.
Qualifications
State Registered Nurse – NMC registration 80D1215E
BA Hons Practitioner Leadership, Manchester Metropolitan University
MSc Leadership Development (Leadership and Management), Edge Hill University
Sue Musson – Non-Executive Director
Sue moved to the UK after graduating and began her career in management consultancy
working with the European Commission and UK government agencies and departments.
She has more than 20 years’ experience as an Executive and Non-Executive Director in large
commercial and public sector organisations. She currently runs her own management
consultancy business and a property holding company.
She was appointed to the Bridgewater Board in January 2012. She resigned her position as a
Non-Executive Director of Bridgewater on 31 December 2014.
Sue also held the position of Senior Independent Director. It is a requirement for Foundation
Trusts to appoint a Senior Independent Director (SID) who is available to members and governors if they have concerns that cannot be resolved through normal channels. This position
was held by Sally Yeoman from 1 January 2015.
Qualifications
BA First-Class Honours in History (Columbia University, New York)
52
Christine Samosa - Director of People, Planning and Development
Christine has more than 30 years’ experience in human resources, training and organisational
development. She has spent the majority of her career in NHS organisations including
primary care trusts, community trusts, mental health trusts and a specialist tertiary centre and
held a director level position for more than 20 years. She has extensive experience of working
with local and regional officers of the main trade unions within the NHS.
Christine joined Bridgewater on 9 November 2011 and on 1 November 2014, became a
voting director on the Board.
Qualifications
Fellow of the Chartered Institute of Personnel and Development.
Masters Degree in Strategic HR Management with research into the impact of
mergers and acquisitions on staff.
HR Director Development Programme at the NHS North West Leadership Academy
Bob Saunders - Non-Executive Director
Bob started his career in environmental health in London and having worked in a number of
local authorities was appointed to the post of Corporate Director at Wigan Council in 1989. In
addition to responsibility for environmental health, housing, urban renewal, trading standards,
licensing and community safety his portfolio also included corporate strategy, business
planning and performance management.
Bob was originally appointed to the Board of Ashton, Leigh and Wigan Community
Healthcare in 2009 and most recently re-appointed to the Bridgewater Board in April 2013
until 31 March 2017.
Bob also holds the position of Chair of the Quality and Safety Committee
Qualifications
BSc Zoology (London)
BSc Environmental Health (Aston)
Royal Society of Health, Chartered Institute of Housing and Institute of Acoustics
Post Graduate Diploma in Management Studies
PRINCE 2 Project Manager
Colin Scales - Chief Operating Officer
Colin joined the NHS in 1994 after leaving university and has undertaken a range of roles
within commissioning, operational management and the Department of Health during his
career. As an Executive Director he has been responsible for developing strong relationships
between organisations, developing leadership capacity and introducing systems to support
managers to improve the performance of services.
He has experience of working in a number of different NHS Trusts and was a member of a
Trust Board that successfully achieved Foundation Trust status.
Colin joined the Trust on 9 November 2011. From 1 April 2015 Colin Scales was appointed to
53
the post of Chief Executive of the Trust.
Qualifications
BA Hons Degree in Geography, University of Salford
Cranfield University, School of Management, Strategic Leadership Executive Programme, May 2014
NHS Top Leaders Programme 2014/15
Mike Treharne - Executive Director of Finance
Mike is a finance professional with more than 30 years’ experience in the NHS and has been
a Director of Finance for more than 16 years. He has held senior finance posts in a range of
NHS organisations including primary care trusts, university hospitals, district general
hospitals and health authorities. He has also sat on a number of national finance groups.
Mike joined the Board of Bridgewater on 28 February 2011 and also holds the post of Deputy
Chief Executive. He has undertaken various development programmes including the Kings
Fund Executive Director Development and study tours to Harvard & Berkley Universities and
Melbourne, Australia.
Qualifications
BSc (Econ) University College, Cardiff
Member of the Chartered Institute of Public Finance Accountants (CPFA)
Executive Director Development Programme 2003/04 (run jointly by the NHS
Leadership Centre and King’s Fund)
Dr Stephen Ward - Executive Medical Director
Steve qualified as a doctor in 1978 and worked for 30 years in primary care, as a principal
GP in a seven doctor practice in Leyland, Lancashire. He then took on a part time position
as Medical Director for NHS Central Lancashire before moving to the role full time. He has
always had an interest in NHS management and is enthusiastic about the role of new
technologies for the management of long-term conditions.
Steve joined the Board of Bridgewater on 1 July 2011.
Qualifications
MBChB (University of Liverpool)
Diploma Developmental Paediatrics and Ascertainment (University of Salford)
MA Clinical Leadership (Manchester Business School)
GMC Registration: 2439200
Dorothy Whitaker - Non-Executive Director
Dorothy originally trained as a nurse and worked in London before returning to the North
West. She has 20 years’ experience in the third sector and has undertaken a range of roles
involving the development of innovative solutions to health and social care issues. Her final
post was as Chief Officer for Blackburn with Darwen Council for Voluntary Service.
54
Dorothy was appointed to the Board of NHS Ashton, Leigh and Wigan Primary Care Trust in
2006 and later joined the predecessor organisation to Bridgewater (Ashton, Leigh and Wigan)
Community Healthcare in March 2008. She was re-appointed to the Board of Bridgewater on
1 November 2014 for a term until 31 October 2015.
Dorothy also holds the position of Vice Chair.
Qualifications
State Registered Nurse Certificate
OU Post Experience Certificate – Handicapped Person in the Community.
Sally Yeoman - Non-Executive Director
Sally started her career working in services for adults with learning disabilities and has since
had more than 10 years’ experience leading charitable organisations which support
community, voluntary, not for profit and faith groups. She is an Institute of Directors certified
Company Director and is currently Chief Executive Officer at Halton and St Helens Voluntary &
Community Action.
Sally was appointed to the Board of Bridgewater on 1 January 2012 for a term until
31 December 2015. From 1 January 2015 Sally held the position of Senior Independent
Director. It is a requirement for Foundation Trusts to appoint a Senior Independent Director
(SID) who is available to members and governors if they have concerns that cannot be
resolved through normal channels.
Qualifications
BSc (Hons) in Sociology
Institute of Directors Certificate in Company Directorship
More detail on individual directors is available on the Board Profiles page of our Trust website
www.bridgewater.nhs.uk
Trust Board meetings
The Board of Directors met monthly during the reporting period, holding a total of 5 meetings.
The Board rotates its meetings so that they are held in the main boroughs that we serve.
Members of staff, the public and the media are entitled to attend part one of the meeting, the
papers for which are made available on the Trust website www.bridgewater.nhs.uk
A Register of Director Attendance at Trust Board meetings is attached as Appendix 1.
Balance, completeness and appropriateness of Board membership
Our board is satisfied that it has the appropriate balance of knowledge, skills and experience
to enable it to carry out its duties effectively. This is supported by the Council of Governors
which takes into consideration the collective performance of the board via the nomination
committee. Throughout the reporting period however, the Trust has seen the resignation of
one non-executive director and will seek to appoint to board vacancies to ensure the balance
of the board is maintained.
55
Performance Evaluation of Board
The Board of Directors was not subject to any external assessment of its performance
during the year. However, the function and performance of the Board was subject to a
rigorous evaluation as part of the Monitor assessment process to become a Foundation Trust.
The performance of the Executive Directors is evaluated by the Chief Executive. The
performance of the Chief Executive and Non-Executive Directors is evaluated by the
Chairman on an annual basis. The performance of the Chairman is evaluated by the Senior
Independent Director, having sought input from Directors and Governors on an annual basis.
All senior managers’ contracts are permanent and not subject to any unexpired term. There is
explicit provision for early or summary termination of employment included in the contracts of
employment for all senior managers as a consequence of gross misconduct or other action
which would lead or warrant the person unable or ineligible to fulfil their contract as a Trust
Board Director. The terms of office for our Chairman and Non-Executive Directors are outlined
in their board profiles above.
The process for appointment of the Chairman and Non-Executive Directors is agreed by the
Council of Governors’ Nomination Committee. In summary the process includes: a review of
the balance of skills, knowledge and experience on the Board; preparation of the role
description and person specification; agreement of a suitable process of open competition to
identify potential candidates; agreement of a short listing and interview process and finally, a
recommendation to the Council of Governors on the appointment.
Non-Executive Directors’ appointments may be terminated on performance grounds or for
contravention of the qualification criteria set out in the Constitution with the approval of three
quarters of the Council of Governors or by mutual consent for other reasons. There is no
provision for compensation for early termination or liability on the Trust’s part in the event of
termination.
Register of interests
A Register of Directors’ Interests is maintained by the Trust and can be accessed on request
to the Trust Secretary.
The Chairman has had no other significant commitments or any that have changed during the
reporting year.
Director Expenses
During the reporting period, 5 Directors claimed a total of £8,000 relating to car allowances
and associated travel expense reclaims.
Board committees
The Board of Directors has five formal committees. A Register of Director Attendance at
Board Committee meetings is attached as Appendix 2.
Audit Committee
The aim of the Audit Committee is to provide the Board of Directors with a means of
independent and objective review of financial and corporate governance, assurance
processes and risk management across the whole of the Trust’s activities (clinical and
56
non-clinical) both generally and in support of the Annual Governance Statement.
A register of attendance for Audit Committee is as follows:
Audit Committee
Karen
Non-Executive Director (Chair)
Bliss
Steve
Non-Executive Director (appointed to
Cash
committee in Dec 2014)
Baron
Non-Executive Director (left Trust
Frankal
31/05/14)
Bob
Non-Executive Director
Saunders
Dorothy
Whitaker
Apr
Jun
Sept
Dec
Feb
Total
I
I
I
I
I
5/5
I
I
2/5
AP
0/5
I
I
I
I
I
5/5
I
I
I
I
AP
4/5
In addition, the Audit Committee:
• Provides assurance of independence for external and internal audit
• Ensures that appropriate standards are set and compliance with them is monitored,
in non-financial, non-clinical areas that fall within the remit of the Audit Committee
• Monitors corporate governance (e.g. compliance with codes of conduct, standing
orders, standing financial instructions, maintenance of registers of interests).
• Ensures the provision of an effective system of internal control and risk management
including the Trust’s financial controls
During the financial reporting period for 2014/15 the Committee consisted of four
Non-Executive Directors, one of whom is the Chair, and one of whom is the Chair of the
Quality and Safety Committee.
The Committee has met on two occasions throughout the reporting period. The Chair Karen
Bliss is a qualified Chartered Accountant, and the Director of Finance, Medical Director, and
the Internal Audit Manager attend routine meetings of the Audit Committee.
External audit representatives and a representative of the local counter fraud service also
regularly attend Audit Committee meetings as do Trust Directors and/or their staff in respect
of issues which the Audit Committee consider to be of risk or special interest.
A schedule of attendance at the meetings is provided in Appendix 2 which demonstrates full
compliance with the quorate requirements and regular attendance by those invited by the
Committee.
The Trust’s internal audit function is carried out through Mersey Internal Audit. The Trust’s
external auditors are Grant Thornton.
Self Assessment:
During the financial reporting period for 2014/15 the Committee have complied with ‘good
practice’ recommended through:
• Agreement of Internal and External Audit and Counter Fraud plans
57
•
•
•
•
Regular review of progress and outcomes, ie risks identified and action plans agreed
Private meetings with External and Internal Audit
Regular review of the Audit Committee workplan
Review of the Committee’s Terms of Reference
Audit Committee Business
Counter Fraud
During the year, the Committee has reviewed the progress of the Local Counter Fraud
Specialist’s programme of work. The Counter Fraud Plan has been delivered in accordance
with the schedule of days agreed with the Committee at the start of the financial year.
Internal Audit
Throughout the year the Committee has worked effectively with the internal auditors to
strengthen the Trust’s internal control processes. The Internal Audit Plan has been delivered
in accordance with the schedule of days agreed with the Committee at the start of the
financial year. During the year, some agreed amendments to the plan had been approved by
the Audit Committee. The Committee Chair reported these amendments to the Board.
During the year under review, Internal Audit has completed 26 reviews, covering both clinical
and non-clinical systems and processes.
The following reports were issued with High Assurance during the year:
Financial & Commercial Systems & Processes
• General Ledger
• Non-pay Expenditure
The following reports were issued with Significant Assurance during the year:
Corporate governance systems and processes
• Risk Management
• Post Francis 2 Review 2013-14
• Quality & Safety Committee Arrangements
• SystmOne & IG Governance
• SUI Follow Up Review
• Income and Debtors
• Cash and Bank
• ESR (HR/Payroll)
• Recruitment Processes Follow Up
Strategic Planning and Service Delivery Systems & Processes
• Critical Application – SOEL Dental Health
• Critical Application – Microsoft Data Warehouse
• QIA/CIP Review
• Performance Data Review
• Emergency Preparedness
• New Domain Review
58
The following reports were issued with Limited Assurance during the year:
Corporate governance systems and processes
• Serious Untoward Incidents (SUI’s) including Actual Harm
• Safeguarding Review
• ESR (HR/Payroll)
• Recruitment Processes
• iOS Management
• Telephony (VOIP) Review
• Network Infrastructure Review
• Financial Systems Technical Security Review
Strategic Planning and Service Delivery Systems & Processes
• Data Consistency Review (Phase I)
The Committee has ensured that, where gaps in assurance are identified, appropriate action
plans are agreed with management, and progress against these plans is regularly reviewed,
by management, internal audit and the committee.
The Trust has established a finance committee which will look at the challenges and issues
associated with financial planning and forecasting, and the Audit Committee will seek
assurances in respect of the processes and work undertaken.
Auditor Disclosures
So far as the directors are aware, there is no relevant audit information of which the NHS
Foundation Trust’s auditors are unaware.
The directors have taken all steps that they ought to have taken as directors to make
themselves aware of any relevant audit information. Furthermore, the Trust has made all
relevant audit information available to the external auditors Grant Thornton and the cost of
work performed by them in the accounting period is as follows:
Category
Audit services
Further assurance services
Other services
Total
Amount (£000)
53
0
0
53
Grant Thornton do not provide any non-audit services.
Grant Thornton were previously the auditors to Bridgewater Community Healthcare NHS Trust
and this had been the case for the 2014/15 period only. This arrangement was carried
forward into the new Foundation Trust for 2014/15.
The duty to appoint the External Auditors now lies with the Council of Governors and it is
anticipated that a competitive tendering process will take place for external audit services
during 2015/16.
59
Nominations and Remuneration Committee
The overarching role and purpose of the Nominations and Remuneration Committee is to be
responsible for identifying and appointing candidates to fill all the Executive Director positions
on the Board and for determining their remuneration and other conditions of service.
Before an appointment is made, the Committee is responsible for evaluating the balance of
skills, knowledge and experience on the Board and, in the light of this evaluation, prepare
a description of the role and capabilities required for a particular appointment. The process
for identifying suitable candidates includes using open advertising or the services of external
advisers to facilitate the search; considering candidates from a wide range of backgrounds;
on merit and against objective criteria. The Council of Governors Nominations Committee
follows this process for Non-Executive appointments and the Trust Board Nominations and
Remuneration Committee is responsible for the appointment of Executive Directors.
Kate Fallon, whilst not a member of the committee, attended in an advisory capacity,
particularly in relation to the appointment of the Chief Nurse and the retirement of the Medical
Director.
During this period, the Nominations and Remuneration Committee were responsible for the
recruitment of two executive posts: Chief Executive Officer and Chief Nurse. Both
appointments will commence on 1 April 2015.
The Chairman of the Trust chairs this Committee and in accordance with the NHS Foundation
Trust Code of Governance it is comprised exclusively of Non-Executive Directors
Quality and Safety Committee
The Quality and Safety Committee enables the Board to obtain assurance that high
standards of care are provided by the Trust and, in particular, that adequate and appropriate
governance structures, processes and controls are in place throughout the Trust.
The committee’s duties include the review and approval of the Trust’s Quality Strategy,
underpinning frameworks and supporting plans/strategies and the agreement of quality
governance priorities to inform strategy and to give direction to quality governance activities
across service areas.
The Committee reviews compliance with policy in relation to Infection Prevention and Control,
Health and Safety, Complaints, Claims, Incident reporting, Safeguarding and Equality and
Diversity.
A schedule of attendance at the meetings is provided in Appendix 2.
Trust Efficiency and Assurance Committee (known as Finance Committee from 1 April 2015)
The Committee is responsible for monitoring the overall financial performance of the
organisation including the delivery of the cash-releasing efficiency savings and within this to
be satisfied that any risks to quality have been mitigated to an acceptable level.
Its duties are to:
• Oversee the financial performance of the organisation, reporting to the Board the likely
future financial position of the Trust.
60
•
•
•
•
Ensure delivery of the Trust’s cash-releasing efficiency savings schemes (CRES).
Oversee the design and delivery of future CRES schemes.
Make recommendations as to the content of financial and investment policies.
Keep under review the content and application of the Trust’s financial, investment and
borrowing strategies and policies.
A schedule of attendance at the meetings is provided in Appendix 2.
The Investment Committee
This Committee did not meet during the reporting period. Its responsibilities have now been
incorporated into those of the Finance Committee.
Council of Governors
The Trust has a Council of Governors which consists of both elected and appointed
governors. The Council of Governors contributes to the development of the Trust strategy and
works with the Trust Board to forward plan. It will be involved in service development through
member engagement. Governors have responsibility for the following decisions:
•
•
•
•
•
•
•
•
•
•
•
Appointing the Chairman;
Appointing the Non-Executive Directors;
Approving the appointment of the Chief Executive;
Removing the Chairman and Non-Executive Directors;
Agreeing Non-Executive Directors’ terms and conditions, and
Approving changes to the Constitution. Governors’ responsibilities include:
Holding the Non-Executive Directors individually and collectively to account for the
performance of the Board;
Appointing and removing Auditors;
Receiving the Annual Report and Accounts;
Being consulted on proposed changes and providing feedback on the future direction
of the NHS Foundation Trust, and
Representing the interests of members and public.
The Trust was already operating a Council of Governors in shadow form, following elections
in September 2013, in preparation for becoming a Foundation Trust. Following
authorisation, formal Council of Governor meetings were held in November 2014, December
2014 and March 2015. Details of Director and Governor attendance at these meetings are
available in Appendix 3.
The Council of Governors comprises a total of 33 Governor seats, of which 18 are elected
Public Governors, nine are elected Staff Governors and six are appointed Partner
Governors. The names of the Governors, the seats they hold and their appointment tenures
are set out below: The Council is chaired by the Trust’s Chairman and the Lead Governor is
John Prince.
61
Name
Appointed/
Nominated or
Elected to post
Constituency
Class
Irene Deakin
Public
Community
Dental
Elected
Nano Nagle Hill
Public
Halton
Elected
Unopposed
Diane
McCormick
Public
Halton
Elected
Unopposed
Dave Oldham
Public
Halton
Elected
Unopposed
Sue Irvine
Public
Rest of
England
Elected
Peter Appleby
Public
St Helens
Elected
Rita
Chapman
Public
St Helens
Elected
Bill Harrison
Public
St Helens
Elected
Derek Maylor
Public
St Helens
Elected
Jean Ball
Public
Warrington
Elected
Liz Matthews
Public
Warrington
Elected
Derek
Saunders
Public
Warrington
Elected
G. Scott Baron
Public
Warrington
Elected
Julie Atherton
Public
Wigan
Elected
Sylvia Cunliffe
Public
Wigan
Elected
62
Tenure
14 October 2013
to 13 October
2016
14 October 2013
to 13 October
2016
14 October 2013
to 13 October
2016
14 October 2013
to 13 October
2016
14 October 2013
to 13 October
2016
14 October 2013
to 13 October
2016
14 October 2013
to 13 October
2016
14 October 2013
to 13 October
2015
14 October 2013
to 13 October
2015
14 October 2013
to 13 October
2016
14 October 2013
to 13 October
2015
27 January 2014
to 13 October
2015
14 October 2013
to 13 October
2016
14 October 2013
to 13 October
2016
14 October 2013
to 13 October
2016
Three years
Three years
Three years
Three years
Three years
Three years
Three years
Two years
Two years
Three years
Two years
Two years (will
serve one year
eight months)
Three years
Three years
Three years
Name
Constituency
Class
Appointed/
Nominated or
Elected to post
James
Roberts****
Public
Wigan
Elected
Unopposed
14 October 2013
to 13 October
2015
Two years (will
serve one year
and five months)
John Prince
Lead
Governor –
elected 11
August 2014
Public
Wigan
Elected
Unopposed
14 October 2013
to 13 October
2016
Three years
Gary Young
Public
Wigan
Elected
Unopposed
14 October 2013
to 13 October
2015
Two years
Charlotte
Dixon*****
Staff
Clinical
Support
Services
Elected
23 June 2014 to
22 June 2017
Three years
Carol Lever
Staff
Allied Health
Professions
Elected
Unopposed
Steven Lowe
Staff
Allied Health
Professions
Elected
Unopposed
Angela Akers
Staff
Dentists
Elected
Vikki Morris
Staff
Non-Clinical
Support
Elected
Corina CaseyHardman
Staff
Nursing and
Midwifery
Elected
Unopposed
Karen
Worthington
Staff
Nursing and
Midwifery
Elected
Unopposed
Vacancy ***
Staff
Vacancy
Staff
Cllr J Pearson
Partner
Nursing and
Midwifery
Doctors/
Medical
St Helens
Health and
Wellbeing
Board
Janette Gray
Partner
Higher
Education
Keith Cunliffe
Partner
Wigan Health
and Wellbeing
Board
Tenure
14 October 2013
to 13 October
2016
14 October 2013
to 13 October
2016
14 October 2013
to 13 October
2016
14 October 2013
to 13 October
2016
14 October 2013
to 13 October
2016
14 October 2013
to 13 October
2016
Three years
Three years
Three years
Three years
Three years
Three years
Elected
Three years
Elected
Three years
Nominated
Nominated
Nominated
14 October 2013
to 13 October
2019
14 October 2013
to 13 October
2019
14 October 2013
to 13 October
2019
Six years
Six years
Six years
63
Name
Constituency
Class
Appointed/
Nominated or
Elected to post
Cllr Peter Lloyd
Jones*
Partner
Halton Health
and Wellbeing
Board
Nominated
23 June 2014 to
13 October 2019
Six years
Mick Taylor
Partner
CVS
Nominated
14 October 2013
to 13 October
2019
Six years
Partner
Warrington
Health and
Wellbeing
Board
Nominated
23 June 2014 to
13 October 2019
Six years
Cllr Judith
Guthrie**
Tenure
Changes to the Council of Governors during the year 2014/15:
*Peter Lloyd Jones, Partner Governor, Halton Council – in position since 23 June 2014,
replacing the previous nominee Councillor Keith Morley
**Judith Guthrie, Partner Governor, Warrington Council – in position since 23 June 2014,
replacing the previous nominee Simon Kenton
***Gill Yates, Staff Governor for Nursing and Midwifery – resigned position as at 1 November
2014 (position currently vacant)
****Jill Nye, Public Governor, Wigan, resigned position from 31 March 2014. Replaced by
James Robert Roberts from 25 April 2014
*****Charlotte Dixon, Staff Governor, Clinical Support Services in position from 23 June 2014
(position previously vacant)
As a newly established Foundation Trust in our first year of operation, we are developing our
systems for Governor engagement. Details of Governors for each constituency are available
on our website and public members can get in touch with their governor through the
dedicated email [email protected] or through contacting the
Trust Secretary. Public governors hold regular meeting surgeries for their respective members
to allow them to raise any comments, issues or concerns. Staff members are able to contact
their governors via email or through normal internal communication channels.
Governor candidates for the Public and Staff Governor seats disclosed their interests as part
of the election process and this disclosure requirement obliged Governors to declare any
political affiliations and any financial or other interests in the Trust. A copy of these
disclosures is lodged within the Governors section of the Trust’s website.
The senior independent director, Sally Yeoman is available to the governors if they have
concerns that contact through the normal channels of chairman, chief executive, finance
director or Trust secretary have failed to resolve or for which such contact is inappropriate.
This information was made available to the Council of Governors via a presentation made by
the SID and forms part of the role description for the SID.
64
All Directors of the Trust have a standing invitation to attend Council of Governors meetings
and similarly all Governors are routinely invited to attend to observe those meetings of the
Board of Directors which are held in public. All Directors of the Trust attend the Council of
Governor meetings on a regular basis in order to develop an understanding of the views of
the Governors and members on the Trust. The agendas for these meetings are structured to
enable Governors to ask questions of the Board of Directors.
The Governors have not exercised their power under paragraph 10C of schedule 7 of the
NHS Act 2006 to require one or more of the Directors to attend a Governor’s meeting for the
purpose of obtaining information about the Trust’s performance of its functions or the
Directors’ performance of their duties. They have not proposed a vote on the Trust’s or
Director’s performance during the reporting year.
Membership
We engage with our communities through our Foundation Trust members, who play an
active role in helping to shape health services for the future. Membership is free and open to
anyone aged 14 years and above who lives in England.
Our membership is divided into public and staff constituencies. Public members are
allocated to their geographic constituency based on where they live and staff are added to
the relevant constituency based on their job role. A breakdown of membership
constituencies is provided in the table below.
Our staff are automatically enrolled as members unless they choose to opt out and as at the
31 March 2015 we had 2,812 staff members.
In October 2014, we achieved our ambition to recruit 10,000 public members representing
65
the nine North West boroughs served by the organisation. The number of members does not
remain constant and following a routine cleanse of our database, by 31 March 2015 the
number of public members stood at 9,694. However, this was an increase from 9,221 at the
end of the 2013/14 reporting period.
Membership Constituency – Staff (as at 31 March 2015)
Allied Health Professionals/ Other Registered Healthcare
Professionals
Clinical Support Staff
Medical and Dental
Non Clinical Support Staff
Registered Dentists
Registered Medical Practitioners
Registered Nurses and Midwives
478
2
756
47
36
1038
Total
2812
Membership Constituency – Public (as at 31 March 2015)
Warrington
Community dental
Ashton Leigh and Wigan
Halton
St Helens
Rest of England
2036
179
2688
1193
1740
1858
Total
9694
455
During the year our work in engaging our members was highlighted at a national conference
in Durham aimed at patient engagement and membership leads. At this event Bridgewater
highlighted how it has capitalised on the contributions made by its members and how their
continued support has supported our ambition to make the organisation patient focused and
focused on the provision of high quality patient care.
Our public members are recruited from those communities and play an important role in our
business. Working with colleagues in the local authority, Clinical Commissioning Groups
(CCGs) and hospital trusts we canvas the views of our members to find out what is working
well and where we can make improvements.
Recruitment of members is supported by a robust system and procedure and our member
information is protected by the Data Protection Act. These systems were scrutinised during
the year by auditors from Mersey Internal Audit and were found to be robust. Our systems
allow us to monitor whether our membership is representative of the communities we serve
through monitoring protected characteristics including gender, age, ethnicity, disability.
Monthly membership reports are shared with our Governor and Non-Executive colleagues
and opportunities for engagement are regularly highlighted.
Our members regularly receive a newsletter outlining the main developments and
achievements of the Trust and are invited to a number of public events including our annual
staff awards, annual members meeting and annual general meeting. Members can decide
66
how involved they would like to be in the work of the Trust. Many have also attended one of
several workshops, focus groups organised by our staff and partners looking at the work
they do and how it might be improved to better meet the needs of the communities we serve.
As an organisation it is extremely important to find out what our members/patients think of
the services we provide and in 2014 our Census Event provided us with the overwhelming
approval.
When we asked the question of our members / patients if they would recommend the
services we provide to their family friends 98 per cent of the 355 people who responded said
they would.
This event was replicated during the week of March 23-27 2015 and the results of this
exercise will be published in our annual report next year.
Our members and elected governors attend events including those organised by our
Healthwatch and CCG colleagues. We also take the opportunity of attending key local events
including the Disability Awareness Day in Warrington, the Vintage Steam Rally in Widnes and
the Party in the Park in Leigh. These events provide a great opportunity of not only talking to
our members, discussing our work, our plans for the future but recruiting new members too.
The continued support of our members in the work of the Trust is extremely valuable and we
are extremely grateful to those members who have given up their time in support of our
organisation. This includes reading patient leaflets, information sheets, and commenting on
the development of our Internet site is extremely valuable and allows us to incorporate the
views of those we serve in the information we produce.
This work is extremely important to us and is supported by our membership strategy and
action plan which was updated in July 2014 to reflect the ambitions of the organisation’s five
year plan. It is important our focus and that of our partners reflects the needs of our patients
and members.
During 2015/16 there will be greater focus in engaging our members in the development of
services and critically appraising the work we do in our main health centres and clinics.
If you wish to become a member, you can find out more and sign up online at
www.bridgewater.nhs.uk/ft/ or contact our Membership Team on 01942 482672 or email
[email protected] to find out more.
Any member – public or staff – can raise issues with governors representing the area in
which they live or work through a dedicated email address
[email protected]
67
Systems of Internal Control
The Board and its subcommittees are responsible for monitoring the Trust’s governance
structure and systems of internal control to ensure that risk is managed to a reasonable level
and that governance arrangements exist to enable the Trust to adhere to its policies and
achieve its objectives.
The Board assessed its own performance with regard to risk management and systems of
internal control through the Quality Governance Assessment Framework (QGAF) and Board
Governance Assessment Framework (BGAF) in preparation for our Monitor assessment.
Ongoing assurance that the Board is sighted on its key strategic risks is provided in the
Board Assurance Framework (BAF)
During the year we received an internal audit assessment of our systems of internal control
and received a rating of “significant assurance”.
More detail is contained in the Annual Governance Statement.
NHS Foundation Trust Code of Governance
Bridgewater Community Healthcare NHS Foundation Trust has applied the principles of the
NHS Foundation Trust Code of Governance on a comply or explain basis. The NHS
Foundation Trust Code of Governance, most recently revised in July 2014, is based on the
principles of the UK Corporate Governance Code issued in 2012. Annual Report: Code of
Governance Requirements
68
Part of
schedule A
(see above)
2: Disclose
Relating to
Board and Council
of Governors
Code of
Governance
reference
A.1.1
Summary of
requirement
The schedule of matters reserved
for the board of directors should
include a clear statement detailing
the roles and responsibilities of the
council of governors. This
statement should also describe how
any disagreements between the
council of governors and the board
of directors will be resolved. The
annual report should include this
schedule of matters or a summary
statement of how the board of
directors and the council of
governors operate, including a
summary of the types of decisions
to be taken by each of the boards
and which are delegated to the
executive management of the board
of directors.
Trust Response
The Trust has a
Governance
manual which sets out the
matters reserved to the
Board. There is a clear
description in this report
which sets out the
responsibilities of the
council of Governors.
The senior independent
director has outlined to
Governors her role in the
resolution of any disputes
between the CoG and the
Board of Directors.
In this first year of
operation the Trust is
reviewing its schedule of
matters reserved to the
Board.
Contained within section
3 – Directors report
2: Disclose
Board, Nomination
Committee(s),
Audit Committee,
Remuneration
Committee
A.1.2
2: Disclose
Council of
Governors
A.5.3
The annual report should
identify the chairperson, the deputy
chairperson (where there is one),
the chief executive, the senior
independent director (see A.4.1)
and the chairperson and members
of the nominations, audit and
remuneration committees. It should
also set out the number of meetings
of the board and those
committees and individual
attendance by directors.
The annual report should
identify the members of the council
of governors, including a
description of the constituency or
organisation that they represent,
whether they were elected or
appointed, and the duration of their
appointments. The annual report
should also identify the nominated
lead governor.
3 – Directors Report and
Appendix 2
Contained within Section
3 – Directors report ,
Composition of Council of
Governors
69
Part of
schedule A
(see above)
Additional
requirement of
FT ARM
Relating to
Council of
Governors
Code of
Governance
reference
n/a
2: Disclose
Board
B.1.1
2: Disclose
Board
B.1.4
Additional
requirement of
FT ARM
Board
n/a
2: Disclose
Nominations
Committee(s)
B.2.10
Additional
requirement of
FT ARM
Nominations
Committee(s)
n/a
2: Disclose
Chair / Council of
Governors
B.3.1
70
Summary of
requirement
The annual report should include
a statement about the number of
meetings of the council of
governors and individual attendance
by governors and directors.
The board of directors should
identify in the annual report each
non-executive director it considers
to be independent, with reasons
where necessary.
include in its annual report a
description of each director’s skills,
expertise and experience. Alongside
this, in the annual report, the board
should make a clear statement
about its own balance,
completeness and appropriateness
to the requirements of the NHS
foundation trust.
The annual report should include
a brief description of the length of
appointments of the non-executive
directors, and how they may be
terminated.
A separate section of the annual
report should describe the work
of the nominations committee(s),
including the process it has used in
relation to board appointments.
The disclosure in the annual report
on the work of the nominations
committee should include an
explanation if neither an external
search consultancy nor open
advertising has been used in the
appointment of a chair or
non-executive director.
A chairperson’s other significant
commitments should be disclosed
to the council of governors before
appointment and included in the
annual report. Changes to such
commitments should be reported
to the council of governors as they
arise, and included in the next
annual report.
Trust Response
3 – Directors Report
Attendance is contained
within Appendix 5
Not applicable
Contained within Section
3 – Directors report, in
this case not applicable
Part of
schedule A
(see above)
2: Disclose
Additional
requirement of
FT ARM
Relating to
Council of
Governors
Council of
Governors
Code of
Governance
reference
B.5.6
n/a
Summary of
requirement
Governors should canvass the
opinion of the trust’s members and
the public, and for appointed
governors the body they represent,
on the NHS foundation trust’s
forward plan, including its
objectives, priorities and strategy,
and their views should be
communicated to the board of
directors. The annual report should
contain a statement as to how this
requirement has been undertaken
and satisfied.
If, during the financial year, the
Governors have exercised their
power* under paragraph 10C** of
schedule 7 of the NHS Act 2006,
then information on this must be
included in the annual report.
Trust Response
Not applicable
This is required by paragraph 26(2)
(aa) of schedule 7 to the NHS Act
2006, as amended by section 151
(8) of the Health and Social Care
Act 2012.
* Power to require one or more of
the directors to attend a governors’
meeting for the purpose of
obtaining information about the
foundation trust’s performance of its
functions or the directors’
performance of their duties (and
deciding whether to propose a vote
on the foundation trust’s or
directors’ performance).
** As inserted by section 151 (6)
of the Health and Social Care Act
2012)
2: Disclose
Board
B.6.1
The board of directors should state Contained within section
in the annual report how
performance evaluation of the
board, its committees, and its
directors, including the chairperson,
has been conducted.
71
Part of
schedule A
(see above)
2: Disclose
2: Disclose
Board
Code of
Governance
reference
B.6.2
Board
C.1.1
Relating to
Summary of
requirement
Trust Response
Not applicable
Where there has been external
evaluation of the board and/or
governance of the trust, the external
facilitator should be identified in the
annual report and a statement made
as to whether they have any other
connection to the trust.
The directors should explain in the Contained within section
annual report their responsibility for 3 – Directors Report
preparing the annual report and
accounts, and state that they
consider the annual report and
accounts, taken as a whole, are fair,
balanced and understandable and
provide the information necessary
for patients, regulators and other
stakeholders to assess the NHS
foundation trust’s performance,
business model and strategy.
Directors should also explain their
approach to quality governance in
the Annual Governance Statement
(within the annual report).
See also ARM paragraph 7.98
2: Disclose
Board
C.2.1
2: Disclose
Audit Committee
/ control
environment
C.2.2
The annual report should contain a
statement that the board has
conducted a review of the
effectiveness of its system of
internal controls.
A trust should disclose in the
annual report:
(a) if it has an internal audit
function, how the function is
structured and what role it performs;
or
(b) if it does not have an internal
audit function, that fact and the
processes it employs for evaluating
and continually improving the
effectiveness of its risk
management and internal control
processes.
72
7 - Chair of Audit
Committee’s Annual
Report 2014/15
Part of
schedule A
(see above)
2: Disclose
2: Disclose
Relating to
Audit Committee /
Council of
Governors
Audit Committee
Code of
Governance
reference
C.3.5
C.3.9
Summary of
requirement
If the council of governors does not
accept the audit committee’s
recommendation on the
appointment, reappointment or
removal of an external auditor, the
board of directors should include in
the annual report a statement from
the audit committee explaining the
recommendation and should set out
reasons why the council of
governors has taken a different
position.
A separate section of the annual
report should describe the work of
the audit committee in
discharging its responsibilities. The
report should include:
Trust Response
Not applicable
7 - Chair of Audit
Committee’s Annual
Report 2014/15
• the significant issues that the
committee considered in relation to
financial statements, operations and
compliance, and how these issues
were addressed;
• an explanation of how it has
assessed the effectiveness of the
external audit process and the
approach taken to the appointment
or re-appointment of the external
auditor, the value of external audit
services and information on the
length of tenure of the current audit
firm and when a tender was last
conducted; and
2: Disclose
Board /
Remuneration
Committee
D.1.3
• if the external auditor provides
non-audit services, the value of
the non-audit services provided
and an explanation of how auditor
objectivity and independence are
safeguarded.
Where an NHS foundation trust
Not applicable
releases an executive director, for
example to serve as a non-executive
director elsewhere, the
remuneration disclosures of the
annual report should include a
statement of whether or not the
director will retain such earnings.
73
Part of
schedule A
(see above)
2: Disclose
Relating to
Board
Code of
Governance
reference
E.1.5
2: Disclose
Board /
Membership
E.1.6
2: Disclose
Membership
E.1.4
Additional
requirement of
FT ARM
Membership
n/a
Summary of
requirement
The board of directors should state
in the annual report the steps they
have taken to ensure that the
members of the board, and in
particular the non-executive
directors, develop an
understanding of the views of
governors and members about the
NHS foundation trust, for example
through attendance at meetings
of the council of governors, direct
face-to-face contact, surveys of
members’ opinions and
consultations.
monitor how representative the NHS
foundation trust's membership is
and the level and effectiveness of
member engagement and report on
this in the annual report.
Contact procedures for members
who wish to communicate with
governors and/or directors should
be made clearly available to
members on the NHS foundation
trust's website and in the annual
report.
The annual report should include:
• a brief description of the
eligibility requirements for joining
different membership
constituencies, including the
boundaries for public membership;
• information on the number of
members and the number of
members in each constituency; and
• a summary of the membership
strategy, an assessment of the
membership and a description of
any steps taken during the year to
ensure a representative membership
[see also E.1.6 above], including
progress towards any recruitment
targets for members.
74
Trust Response
3– Directors Report
Part of
schedule A
(see above)
Additional
requirement
of FT ARM
(based on
FReM
requirement)
Relating to
Board / Council of
Governors
Code of
Governance
reference
n/a
Summary of
requirement
Trust Response
Register of Directors
The annual report should disclose
details of company directorships or interests is available from
the Trust Secretary
other material interests in
companies held by governors and/
or directors where those companies
or related parties are likely to do
business, or are possibly seeking to
do business, with the NHS
foundation trust. As each NHS
foundation trust must have
registers of governors’ and
directors’ interests which are
available to the public, an
alternative disclosure is for the
annual report to simply state how
members of the public can gain
access to the registers instead of
listing all the interests in the annual
report.
See also ARM paragraph 7.33 as
directors’ report requirement.
6: Comply or
explain
Board
A.1.4
6: Comply or
explain
Board
A.1.5
6: Comply or
explain
6: Comply or
explain
Board
A.1.6
Board
A.1.7
6: Comply or
explain
Board
A.1.8
The board should ensure that
adequate systems and processes
are maintained to measure and
monitor the NHS foundation trust’s
effectiveness, efficiency and
economy as well as the quality of
its health care delivery
relevant metrics, measures,
milestones and accountabilities
are developed and agreed so as to
understand and assess progress
and delivery of performance
The board should report on its
approach to clinical governance.
The chief executive as the
accounting officer should follow the
procedure set out by Monitor for
advising the board and the council
and for recording and submitting
objections to decisions.
The board should establish the
constitution and standards of
conduct for the NHS foundation
trust and its staff in accordance with
NHS values and accepted standards
of behaviour in public life
Comply
Comply
Comply
Comply
Comply
75
Part of
schedule A
(see above)
6: Comply or
explain
Board
Code of
Governance
reference
A.1.9
6: Comply or
explain
Board
A.1.10
6: Comply or
explain
Chair
A.3.1
6: Comply or
explain
Board
A.4.1
6: Comply or
explain
Board
A.4.2
6: Comply or
explain
Board
A.4.3
6: Comply or
explain
Council of
Governors
A.5.1
6: Comply or
explain
6: Comply or
explain
Council of
Governors
Council of
Governors
A.5.2
6: Comply or
explain
Council of
Governors
Relating to
A.5.4
A.5.5
76
Summary of
requirement
The board should operate a code of
conduct that builds on the values
of the NHS foundation trust and
reflect high standards of probity and
responsibility.
The NHS foundation trust should
arrange appropriate insurance to
cover the risk of legal action against
its directors.
The chairperson should, on
appointment by the council, meet
the independence criteria set out in
B.1.1. A chief executive should not
go on to be the chairperson of the
same NHS foundation trust.
In consultation with the council,
the board should appoint one of the
independent non-executive
directors to be the senior
independent director.
The chairperson should hold
meetings with the non-executive
directors without the executives
present.
Where directors have concerns
that cannot be resolved about the
running of the NHS foundation trust
or a proposed action, they should
ensure that their concerns are
recorded in the board minutes.
The council of governors should
meet sufficiently regularly to
discharge its duties.
The council of governors should not
be so large as to be unwieldy.
The roles and responsibilities of the
council of governors should be set
out in a written document.
The chairperson is responsible for
leadership of both the board and
the council but the governors also
have a responsibility to make the
arrangements work and should take
the lead in inviting the chief
executive to their meetings and
inviting attendance by other
executives and non-executives, as
appropriate.
Trust Response
Comply
Comply
Comply
Comply
Comply
Comply
Comply
Comply
Comply
Comply
Part of
schedule A
(see above)
6: Comply or
explain
Relating to
Council of
Governors
Code of
Governance
reference
A.5.6
6: Comply or
explain
Council of
Governors
A.5.7
6: Comply or
explain
Council of
Governors
A.5.8
6: Comply or
explain
Council of
Governors
A.5.9
6: Comply or
explain
Board
B.1.2
6: Comply or
explain
Board / Council of
Governors
B.1.3
6: Comply or
explain
Nomination
Committee(s)
B.2.1
6: Comply or
explain
Board / Council of
Governors
B.2.2
6: Comply or
explain
Nomination
Committee(s)
B.2.3
6: Comply or
explain
Nomination
Committee(s)
B.2.4
Summary of
requirement
The council should establish a
policy for engagement with the
board of directors for those
circumstances when they have
concerns.
The council should ensure its
interaction and relationship with the
board of directors is appropriate and
effective.
The council should only exercise
its power to remove the chairperson
or any non-executive directors after
exhausting all means of
engagement with the board.
The council should receive and
consider other appropriate
information required to enable it to
discharge its duties.
At least half the board, excluding
the chairperson, should comprise
non-executive directors determined
by the board to be independent.
No individual should hold, at the
same time, positions of director and
governor of any NHS foundation
trust.
The nominations committee or
committees, with external advice
as appropriate, are responsible for
the identification and nomination
of executive and non-executive
directors.
Directors on the board of
directors and governors on the
council should meet the “fit and
proper” persons test described in
the provider licence.
The nominations committee(s)
should regularly review the
structure, size and composition of
the board and make
recommendations for changes
where appropriate.
The chairperson or an independent
non-executive director should chair
the nominations committee(s).
Trust Response
Comply
Comply
Comply
Comply
Comply
Comply
Comply
Comply
Comply
Comply
77
Part of
schedule A
(see above)
6: Comply or
explain
Relating to
Nomination
Committee(s) /
Council of
Governors
Code of
Governance
reference
B.2.5
6: Comply or
explain
Nomination
Committee(s)
B.2.6
6: Comply or
explain
Council of
Governors
B.2.7
6: Comply or
explain
Council of
Governors
B.2.8
6: Comply or
explain
Nomination
Committee(s)
B.2.9
6: Comply or
explain
Board
B.3.3
6: Comply or
explain
Board / Council of
Governors
B.5.1
78
Summary of
requirement
The governors should agree with
the nominations committee a clear
process for the nomination of a
new chairperson and non-executive
directors.
Where an NHS foundation trust has
two nominations committees, the
nominations committee responsible
for the appointment of
non-executive directors should
consist of a majority of governors.
When considering the appointment
of non-executive directors, the
council should take into account the
views of the board and the
nominations committee on the
qualifications, skills and experience
required for each position.
The annual report should describe
the process followed by the council
in relation to appointments of the
chairperson and non-executive
directors.
An independent external adviser
should not be a member of or have
a vote on the nominations
committee(s).
The board should not agree to a
full-time executive director taking
on more than one non-executive
directorship of an NHS foundation
trust or another organisation of
comparable size and complexity.
The board and the council
governors should be provided with
high-quality information appropriate
to their respective functions and
relevant to the decisions they have
to make.
Trust Response
Comply
Not applicable
Comply
Comply
Comply
Comply
Comply
Part of
schedule A
(see above)
6: Comply or
explain
Board
Code of
Governance
reference
B.5.2
6: Comply or
explain
Board
B.5.3
6: Comply or
explain
Board / Committees
B.5.4
6: Comply or
explain
Chair
B.6.3
6: Comply or
explain
Chair
B.6.4
6: Comply or
explain
Chair / Council of
Governors
B.6.5
Relating to
Summary of
requirement
The board and in particular
non-executive directors, may
reasonably wish to challenge
assurances received from the
executive management. They need
not seek to appoint a relevant
adviser for each and every subject
area that comes before the board,
although they should, wherever
possible, ensure that they have
sufficient information and
understanding to enable
challenge and to take decisions on
an informed basis.
directors, especially
non-executive directors, have
access to the independent
professional advice, at the NHS
foundation trust’s expense, where
they judge it necessary to discharge
their responsibilities as directors.
Committees should be provided
with sufficient resources to
undertake their duties.
The senior independent director
should lead the performance
evaluation of the chairperson.
The chairperson, with assistance of
the board secretary, if applicable,
should use the performance
evaluations as the basis for
determining individual and
collective professional development
programmes for non-executive
directors relevant to their duties as
board members.
Led by the chairperson, the council
should periodically assess their
collective performance and they
should regularly communicate to
members and the public details
on how they have discharged their
responsibilities.
Trust Response
Comply
Comply
Comply
Comply
Comply
As a new Foundation
Trust, we intend to
complete within our first
year of operation.
79
Part of
schedule A
(see above)
6: Comply or
explain
Relating to
Council of
Governors
Code of
Governance
reference
B.6.6
6: Comply or
explain
Board /
Remuneration
Committee
B.8.1
6: Comply or
explain
Board
C.1.2
6: Comply or
explain
Board
C.1.3
80
Summary of
requirement
Trust Response
There should be a clear policy and Comply
a fair process, agreed and adopted
by the council, for the removal
from the council of any governor
who consistently and unjustifiably
fails to attend the meetings of the
council or has an actual or potential
conflict of interest which prevents
the proper exercise of their duties.
The remuneration committee should Comply
not agree to an executive member
of the board leaving the
employment of an NHS
foundation trust, except in
accordance with the terms of their
contract of employment, including
but not limited to service of their
full notice period and/or material
reductions in their time
commitment to the role, without the
board first having completed and
approved a full risk assessment.
The directors should report that the Comply
NHS foundation trust is a going
concern with supporting
assumptions or qualifications as
necessary.
See also ARM paragraph 7.17.
At least annually and in a timely
manner, the board should set out
clearly its financial, quality and
operating objectives for the NHS
foundation trust and disclose
sufficient information, both
quantitative and qualitative, of the
NHS foundation trust’s business
and operation, including clinical
outcome data, to allow members
and governors to evaluate its
performance.
Comply
Part of
schedule A
(see above)
6: Comply or
explain
Relating to
Board
Code of
Governance
reference
C.1.4
Summary of
requirement
Trust Response
a) The board of directors must
Would comply if
notify Monitor and the council of
appropriate
governors without delay and should
consider whether it is in the
public’s interest to bring to the
public attention, any major new
developments in the NHS
foundation trust’s sphere of activity
which are not public knowledge,
which it is able to disclose and
which may lead by virtue of their
effect on its assets and liabilities, or
financial position or on the general
course of its business, to a
substantial change to the financial
wellbeing, health care delivery
performance or reputation and
standing of the NHS foundation
trust.
b) The board of directors must
notify Monitor and the council of
governors without delay and should
consider whether it is in the public
interest to bring to public attention
all relevant information which is
not public knowledge concerning a
material change in:
• the NHS foundation trust’s
financial condition;
• the performance of its business;
and/or
• the NHS foundation trust’s
expectations as to its performance
which, if made public, would
be likely to lead to a substantial
change to the financial wellbeing,
health care delivery performance or
reputation and standing of the NHS
foundation trust.
6: Comply or
explain
Board / Audit
Committee
C.3.1
The board should establish an audit Comply
committee composed of at least
three members who are all
independent non-executive
directors.
81
Part of
schedule A
(see above)
6: Comply or
explain
Relating to
Council of
Governors / Audit
Committee
Code of
Governance
reference
C.3.3
6: Comply or
explain
Council of
Governors / Audit
Committee
C.3.6
6: Comply or
explain
C.3.7
6: Comply or
explain
Audit Committee
C.3.8
6: Comply or
explain
Remuneration
Committee
D.1.1
6: Comply or
explain
Remuneration
Committee
D.2.2
6: Comply or
explain
Council of
Governors /
Remuneration
Committee
D.2.3
82
Summary of
requirement
The council should take the lead in
agreeing with the audit committee
the criteria for appointing,
re-appointing and removing external
auditors.
The NHS foundation trust should
appoint an external auditor for a
period of time which allows the
auditor to develop a strong
understanding of the finances,
operations and forward plans of the
NHS foundation trust.
When the council ends an external
auditor’s appointment in disputed
circumstances, the chairperson
should write to Monitor informing it
of the reasons behind the decision.
The audit committee should review
arrangements that allow staff of
the NHS foundation trust and other
individuals where relevant, to raise,
in confidence, concerns about
possible improprieties in matters
of financial reporting and control,
clinical quality, patient safety or
other matters.
Any performance-related elements
of the remuneration of executive
directors should be designed to
align their interests with those of
patients, service users and
taxpayers and to give these
directors keen incentives to perform
at the highest levels.
The remuneration committee should
have delegated responsibility for
setting remuneration for all
executive directors, including
pension rights and any
compensation payments.
The council should consult external
professional advisers to market-test
the remuneration levels of the
chairperson and other
non-executives at least once every
three years and when they intend
to make a material change to the
remuneration of a non-executive.
Trust Response
A task and finish group of
the council of governors
will work with the Chair
of the Audit Committee
to appoint the external
auditors to the Trust.
Comply
There have been no
disputed circumstances
leading to the need to end
the contract.
Comply
The Trust does not have
any performance related
elements to the
remuneration of its
executive directors.
Comply
Comply
Part of
schedule A
(see above)
6: Comply or
explain
Board
Code of
Governance
reference
E.1.2
6: Comply or
explain
Board
E.1.3
6: Comply or
explain
Board
E.2.1
6: Comply or
explain
Board
E.2.2
Relating to
Summary of
requirement
The board should clarify in writing
how the public interests of patients
and the local community will be
represented, including its approach
for addressing the overlap and
nterface between governors and any
local consultative forums.
The chairperson should ensure that
the views of governors and
members are communicated to the
board as a whole.
The board should be clear as to the
specific third party bodies in
relation to which the NHS
foundation trust has a duty to
co-operate.
effective mechanisms are in place
to co-operate with relevant third
party bodies and that collaborative
and productive relationships are
maintained with relevant
stakeholders at appropriate levels of
seniority in each.
Trust Response
Comply, included in
section 3 - Directors
report
Comply
Comply
Comply
Companies Act Disclosures
Other disclosures required within the Directors’ Report that are relevant to our Trust are
included within our Strategic Report. These are:
•
•
•
•
•
•
•
•
Important events since in the end of the financial year affecting our Trust
An indication of likely future developments at the Trust
Policies applied during the financial year for giving full and fair consideration to
applications for employment made by disabled persons, having regard to their
aptitudes and abilities
Policies applied during the financial year for continuing the employment of, and for
arranging appropriate training for, employees who have become disabled persons
during the period
Policies applied during the financial year for the training, career development and
promotion of disabled employees
Actions taken in the financial year to consult employees or their representatives on
a regular basis so that the views of employees can be taken into account in making
decisions which are likely to affect their interests
Actions taken in the financial year to encourage the involvement of employees in the
Trust’s performance
Actions taken in the financial year to achieve a common awareness on the part of all
employees of the financial and economic factors affecting the performance of the
Trust.
83
5.
Enhanced Quality Governance Reporting
The Trust governs service quality through Board meetings, with monthly agenda items on
quality and safety. Quality performance is discussed at the Board’s monthly Quality and
Safety Committee and the Trust’s Senior Management Team also receives information
regarding exceptions and concerns relating to quality. The Trust has a Quality Governance
Assessment Framework (QGAF) in place when we became a Foundation Trust. In 2015/16
we will undertake a review of our governance arrangements against the well-led framework.
Our Quality Strategy outlines our quality priorities for 2014/15, which are linked directly to the
Care Quality Commission five domains:
• Ensuring we are safe
• Ensuring we are effective
• Ensuring we are caring
• Ensuring we are responsive
• Ensuring we are well-led
Each year Trusts are required to publish a Quality Account as required by the NHS Act 2009
and the NHS (Quality Accounts) Regulations 2010. Our Quality Report discharges this
responsibility in Appendix 4.
This document aims to provide a publicly available account and assurance on the quality of
care we provide through providing evidence and progress against key quality measures. It
includes a statement of assurance regarding quality from our Chief Executive, details of
progress against our quality improvement priorities for 2014/15, targets agreed with our
commissioners and an outline of the priorities for 2015/16.
The report also contains details of service improvements within Bridgewater and how we
have worked with our partners to improve the quality of care we provide.
The Quality Report details the mechanisms and systems for ensuring the quality of services
is maintained and details the processes in place for monitoring quality including the Quality
Impact Assessment (QIA) process, Clinical Audit and how we seek feedback from patients
and carers on their experience of our services.
The report also contains information on how we manage Infection, Prevention and Control,
Safeguarding, Clinical Audit and training for our staff to ensure we deliver the highest quality
services.
Information on how quality is managed through the governance framework is available in the
Annual Governance Statement available within this report.
Our Quality Account 2014/15 is contained within Appendix 4 of this annual report.
84
6. Remuneration Report
Annual statement on Remuneration
As Chair of the Remuneration Committee of the Trust I confirm that the remuneration
committee has met on 3 occasions between 1st November 2014 and the 31st March 2015.
The main business conducted related to the process for the appointment of a new Chief
Executive Officer (together with the Council of Governors) and the remuneration for that post,
the appointment of a new Chief Nurse and the retirement of the Trusts Medical Director.
The Medical Director tendered his resignation and took a ‘flexible retirement ‘on 31st
December 2014, returning to work on the 1st February 2015 on a part time basis. He has
subsequently retired in full with effect from the 31st May 2015.
A new Chief Nurse was appointed with effect from 1st April and the salary for that post was
determined using the NHS Very Senior Manager pay framework (VSM) using PCT band 4
scales as the accepted pay scale within the Trust.
The salary of the Chief Executive was determined following a market assessment using
benchmarked information and also information provided by the specialist recruitment
consultants who advised on the salaries of recent Chief Executive appointments that they
had been involved in and the salaries of those candidates for the post that held current
positions of Chief Executive in NHS organisations.
The committee agreed that a maximum salary of £150,000 could be offered to a successful
candidate. The successful candidate was awarded a salary of £150,000.
There have been no changes to the remuneration of any other Director during the above
period and the trust agreed that VSM/ Director salaries would not be increased during
2014/15 and 2015/16 and no cost of living increases have been awarded to Directors.
Harry Holden
Chairman
85
Senior remuneration policy
With the exception of Directors and the CEO, all senior managers within the Trust are
employed on Agenda for Change terms and conditions and associated salary scales.
Bridgewater Community Healthcare NHS Foundation Trust has adopted the NHS VSM pay
framework ( PCT Band 4) as the salary scale for all Directors. This provides a spot salary for
each post, based on a % of the CEO salary. It should be noted that the salaries of all
directors have not been increased as a result of an increase in the CEO salary on 1.4.2015.
There is no facility for performance related pay within the Trusts pay structure. As a
Community Trust , with the requirement to travel across a wide geographical footprint, all
directors are entitled to receive a lease car or take a car allowance equivalent to £5,700 pa.
All Directors are set annual objectives, in line with the organisational strategy and objectives
and are assessed against these on an annual basis. There is input into the assessment from
the Chairman and CEO (for Directors ) . Should any director performance be determined to
be at an unacceptable level, the Trust would use its agreed performance management
policies and procedures.
The assessment period runs from 1st April to 31st March each year.
All Directors have been issued with NHS contracts of employment , with notice periods not
exceeding six months. There is no provision for any additional payments to be made to
Directors over and above their agreed salary level and car allowance. There is no payment
for loss of office , other than those terms contained in section 16 of the Agenda for Change
terms and conditions relating to redundancy situations.
Non-Executive Director Remuneration
The remuneration levels for the Chairman and Non-Executive Directors is as follows:
Chairman: £40,000p.a
NED:£12,000p.a
Allowances for chairs of committees / SID: £1,500pa
There are no additional payments that are considered to be remuneration in nature.
The above remuneration levels were considered and agreed by the Council of governors in
line with the Monitor guidance.
The tables shown on the following pages provide information on the remuneration and
pension benefits for Senior Managers for the period 1 November 2014 to 31 March 2015.
These tables plus their associated narrative (including pay multiples) are subject to External
Audit review.
The remuneration report includes:
• Salaries and Allowances Table
• Pay Multiples
• Exit Packages
• Appointments & Remuneration Committee
• Annual Statement on Remuneration
86
• Senior Remuneration Policy
• Non Executive Director Remuneration
• Pension Benefits - Table
• Cash Equivalent Transfer Values (CETV)
• Real Increase in CETV
Salaries and Allowances
Period from 1 November
2014 to 31 March 2015
Directors Name and title
Taxable
Salary at
benefits at
31.3.2015
31.3.2015**
Performance
pay and
bonuses at
31.3.2015
Long term
performance
pay and
bonuses at
31.3.2015
All
pensionrelated
benefits at
31.3.2015*
TOTAL at
31.3.2015
Bands of
£5,000
£’000s
Total to
nearest
£100
Bands of
£5,000
£’000s
Bands of
£5,000
£’000s
Bands of
£2,500
£’000s
Bands of
£5,000
£’000s
Harry Holden
Chairman
10-15
0
0
0
N/a
10-15
Kate Fallon
Chief Executive
Retired on 31.3.15
55-60
21
0
0
0-2.5
60-65
Linda Agnew
Director of Corporate
Development
40-45
21
0
0
2.5-5
40-45
Dorothy Keates
Interim Executive Nurse/ Director of
Governance
35-40
0
0
0
77.5-80
115-120
Mike Treharne
Director of Finance
& Performance
40-45
21
0
0
0
45-50
Stephen Ward
Medical Director
15-20
10
0
0
0
15-20
Colin Scales
Chief Operating Officer
40-45
24
0
0
0-2.5
40-45
Christine Samosa Director of People,
Planning and Development
35-40
0
0
0
0
35-40
Bob Saunders
5-10
0
0
0
N/a
5-10
Karen Bliss
5-10
0
0
0
N/a
5-10
Steve Cash
5-10
0
0
0
N/a
5-10
Dorothy Whitaker
5-10
0
0
0
N/a
5-10
Sue Musson Non-Executive Director in
post to 31/12/2014
0-5
0
0
0
N/a
0-5
Sally Yeoman
5-10
0
0
0
N/a
5-10
Band of Highest Paid Director’s
Remuneration (£’000s)
60-65
Median Total Remuneration (£) ***
11,658
5.4
Ratio
All of the above Directors were in post for the 5 month period from 1 November 2014 to 31 March 2015 except where
indicated.
* Calculated in line with the prescribed guidance in Chapter 7 of the NHS Annual Reporting Manual for Foundation Trusts
** The taxable benefits disclosed in the above table are car allowances which are received as cash.
*** The median pay has been calculated for the 5 month period from 1 November 2014 to 31 March 2015.
87
Pay Multiples
Reporting bodies are required to disclose the relationship between the remuneration of the
highest-paid director in their organisation and the median remuneration of the organisation’s
workforce.
The mid point of the banded remuneration of the highest paid director in Bridgewater
Community Healthcare NHS Foundation Trust in the period from 1 November 2014 to 31
March 2015 was £62,500. This was 5.4 times the median remuneration of the workforce
which was £11,658 for the same period.
Total remuneration includes salary, non-consolidated performance-related pay,
benefits-in-kind, but not severance payments. It does not include employer pension
contributions and the cash equivalent transfer value of pensions.
Exit Packages
During the period from 1 November 2014 to 31 March 2015 there have been no exit
packages agreed.
Appointments & Remuneration Committee
The Appointments and Remuneration Committee is attended by all Non-Executive Directors
and is chaired by the Chairman of the Trust.
The committee sets the levels of pay for Executive Directors - and senior managers not
remunerated under Agenda for Change pay arrangements.
The committee approves the proposed appointment of Executive Directors. Contracts for
Executive Directors are substantive unless or until the individual elects to resign the role or is
removed from the role. Notice periods for such Directors is six months. There are no
contractual provisions for the early termination of Executive Directors.
The Appointments Commission appoints Non-Executive Directors, generally on 3 year
contracts which can be renewed on expiry. Notice periods are generally one month. There
are no contractual provisions for the early termination of Non-Executive Directors.
Furthermore the committee operates an annual Performance Development Review process
whereby whereby each individual has a named “parent”. At the outset, the postholder and
parent jointly agree the objectives for the following year and performance against these is
then jointly assessed after the twelve month elapses. The cycle is then repeated on an
ongoing annual basis.
88
Pension Benefits
Period from 1
November 2014 to
31 March 2015
Real
increase in
pension at
aged 60
Lump sum at
Cash
Real increase Total accrued
aged 60 related Equivalent
in pension pension as aged
to accrued
Transfer Value
lump sum at 60 at 31 March
pension at 31 at 1 November
aged 60
2015
March 2015
2014
Cash
Equivalent
Transfer
Value at 31
March 2015
Executive
Bands of
Bands of
Bands of
Bands of
Directors
£2,500
£2,500
£5,000
£5,000
£’000s
£’000s
Name
£’000s
£’000s
£’000s
£’000s
Kate Fallon
Chief Executive
0-2.5
0-2.5
25-30
85-90
0
0
Retired 31.3.2015
Linda Agnew
Director of
0-2.5
0-2.5
30-35
90-95
593
620
Corporate
Development
Dorothy Keates
Interim Executive
2.5-5
10-12.5
20-25
70-75
392
484
Nurse / Director
of Governance
Mike Treharne
0-2.5
0-2.5
35-40
110-115
723
734
Director of Finance
& Performance
Stephen Ward
0
0
0
0
0
0
Medical Director
Colin Scales
0-2.5
0-2.5
15-20
45-50
218
226
Chief Operating
Officer
Christine Samosa
Director of People,
0-2.5
0-2.5
35-40
110-115
696
699
Planning and
Development
Real
increase in
Cash
Equivalent
Transfer
Value
£’000s
0
8
88
3
0
5
0
Exit Packages (continued)
* The Medical Director has opted out of the Pension Scheme and therefore no entries have been included above.
There are no entries in respect of pensions for Non-Executive Directors as they do not receive pensionable remuneration.
Additionally there were no contributions to Stakeholder Pensions on behalf of any of the Directors of the Trust.
Cash Equivalent Transfer Values
The benefits valued are the member’s accumulated benefits and any contingent spouse’s
pension payable from the scheme.
A CETV is a payment made by a pension scheme, or arrangement to secure pension
benefits in another pension scheme or arrangement when a member leaves a scheme and
chooses to transfer the benefits accrued in their former scheme.
The pension figures shown relate to the benefits that the individual has accrued as a
consequence of their total membership of the scheme, not just their service in a senior
capacity to which the disclosure applies. The CETV figures, and the other pension details,
include the value of any pension benefits in another scheme or arrangement which the
89
individual has transferred to the NHS pension scheme. They also include any additional
pension benefit accrued to the member as a result of their purchasing additional years of
pension service in the scheme at their own cost. CETV’s are calculated within the guidelines
and framework prescribed by the Institute and Faculty of Actuaries.
Real Increase in CETV
This reflects the increase in CETV effectively funded by the employer. It takes account of the
increase in accrued pension due to inflation, contributions paid by the employee (including
the value of any benefits transferred from another pension scheme or arrangement). There
has been a change in the actuarial factors set by the Government Actuary’s Department
(GAD) with effect from 8 December 2011. NHS Pensions has used the most recent set of
actuarial factors produced by GAD when calculating the CETV for inclusion in the
remuneration report.
90
7.
Annual Governance Statement
Organisation Code RY2
November 2014 to March 2015 Annual Governance Statement
Scope of responsibility
As Accounting Officer, I have responsibility for maintaining a sound system of internal control
that supports the achievement of the NHS foundation trust’s policies, aims and objectives,
whilst safeguarding the public funds and departmental assets for which I am personally
responsible, in accordance with the responsibilities assigned to me. I am also responsible for
ensuring that the NHS foundation trust is administered prudently and economically and that
resources are applied efficiently and effectively. I also acknowledge my responsibilities as set
out in the NHS Foundation Trust Accounting Officer Memorandum. To the best of my
knowledge and belief and from the assurances provided by Dr Kate Fallon, the previous
accountable officer, I am assured that the chief executive responsibilities have been
appropriately discharged over the period November 2014 to March 2015.
The Board Assurance Framework is submitted to the Board for review following scrutiny by
the Quality and Safety Committee and these provide part of the information and assurance
required. The Annual Governance Statement (AGS) is drafted by the Head of Risk
Management. The Head of Internal Audit Opinion contributes towards the required
assurance and this report has been reviewed by Quality and Safety Committee and the
Board. The AGS is discussed at director management team and updated for any comments
and a draft reported to the Board for information. It is then subsequently signed by the Chief
Executive.
The purpose of the system of internal control
The system of internal control is designed to manage risk to a reasonable level rather than to
eliminate all risk of failure to achieve policies, aims and objectives; it can therefore only
provide reasonable and not absolute assurance of effectiveness. The system of internal
control is based on an ongoing process designed to identify and prioritise the risks to the
achievement of the policies, aims and objectives of Bridgewater Community Healthcare NHS
Foundation Trust, to evaluate the likelihood of those risks being realised and the
impact should they be realised, and to manage them efficiently, effectively and economically.
The system of internal control has been in place in Bridgewater Community Healthcare NHS
Foundation Trust to the year ended 31 March 2015 and up to the date of approval of the
annual report and accounts.
Capacity to handle risk
As set out in Section One of the Risk Management Strategy and Policy, the role of Executive
Nurse/Director of Governance holds executive responsibility for establishing risk
management across the Trust, with the Head of Risk Management reporting to them. The
Head of Risk Management has responsibility for developing, embedding, and advising on
risk management systems for operational risks identified by clinical and non-clinical support
services and strategic risks developed by the Board.
Significant operational risks and incidents are reported to the Chief Operating Officer as they
arise in directorates and on a monthly basis to the Quality Management Group (which, in
turn, escalates exceptional information to the committee of the Board, the Quality and Safety
91
Committee), and Directors may offer immediate advice, intervention or support to mitigate the
issue. Controls and Assurance that affect local operational process are managed and
recorded by managers at a directorate level and monitored by the directorate General
Manager at the Directorate Management Teams.
The Trust employs specialists, for example in Health and Safety, Medicines Management,
Information Governance, Security, and Equality and Diversity, to maintain Trust adherence to
regulations and additionally offer advice to staff and management on expected operational
Controls and Assurances to mitigate and monitor risks.
All managers across the Trust maintain a responsibility for the safety of their staff and
patients, and the safe and effective delivery of care as part of the Trust Objectives. Anything
that presented a foreseeable hazard to these was risk assessed and documented on the
Operational Risk Register residing on the Ulysses Risk Management System or, if something
adverse occurred it was recorded on the same system as an incident.
The Head of Risk Management offers monthly training session to managers on risk
assessment and management documented risk assessments on the Operational Risk
Register, where they also receive advice and can raise uncertainties. Risks, complaints,
and incidents are monitored and triangulated by the Quality Management Group and also
the Quality and Safety Committee, with any thematic lessons to be learned provided to the
Lessons Learned Group for Trust-wide dissemination in Team Brief cascade and via the Trust
Intranet.
The risk and control framework
There are two types of risk monitored within the Trust; Strategic and Operational. In
accordance with Section Two of the Risk Management Strategy and Policy, risks are
identified from a range of sources set out in the Policy, including incidents, complaints,
audits etc., considered for escalation to the Ulysses Risk Register or BAF and an assessment
documented on that system. Documented risk information can be updated and amended for
accuracy in Ulysses and saved (an audit trail held within the system) or a risk may be
re-assessed and a new ‘version’ number applied indicating that the issue has been
re-evaluated.
The Trust used a consistent risk assessment methodology as defined in the Risk
Management Strategy for all risk (both Strategic and Operational) based on: •
•
•
•
•
Hazard identification
Impact evaluation
Identification of Controls, Assurance and any gaps in these,
Using the NPSA Risk Matrix for grading and initially prioritising risks, and
Treating Control and Assurance gaps through Action Plans with completion dates to
reach target tolerable levels of risk
The Trust employs specialists, for example in Health and Safety, Medicines Management,
Information Governance, Security, and Equality and Diversity, to maintain Trust adherence to
regulations and additionally offer advice to staff and management on expected operational
Controls and Assurances to mitigate and monitor risks.
92
All managers across the Trust maintain a responsibility for the safety of their staff and
patients, and the safe and effective delivery of care as part of the Trust Objectives. Anything
that presented a foreseeable hazard to these was risk assessed and documented on the
Operational Risk Register residing on the Ulysses Risk Management System or, if something
adverse occurred it was recorded on the same system as an incident.
The Head of Risk Management offers monthly training session to managers on risk
assessment and management documented risk assessments on the Operational Risk
Register, where they also receive advice and can raise uncertainties. Risks, complaints,
and incidents are monitored and triangulated by the Quality Management Group and also
the Quality and Safety Committee, with any thematic lessons to be learned provided to the
Lessons Learned Group for Trust-wide dissemination in Team Brief cascade and via the Trust
Intranet.
The most consistent set of principal Controls the Board expects are established policies and
procedures. These have been inherited by the Foundation Trust since its function as an NHS
Trust. Assurance of implementation and adherence to these standards and processes are
monitored through staff training figures and incidents or complaints captured in the
Integrated Performance Report and the Quality Dashboard to the Board. The Board focuses
on patient and service experience as a reflection of the culture of the Trust.
A range of descriptive severity and likelihood examples are included in the Policy appendices
to ensure a consistent approach to grading the severity and likelihood of a risk and this is
reinforced in the monthly training sessions. The Board receives an annual risk management
training session from the Head of Risk Management.
The Board have enshrined within the Policy the tolerable levels of risk, beyond which they
require detailed information to be assured that steps are being taken to mitigate the likelihood
or impact. Based on the NPSA (from the Aus/NZ risk methodology) 5 x 5 matrix used widely
across the NHS, the Board considers any risks scoring 12 and above to be Significant and
liable to further scrutiny and support, and any risks that possess a severity element adjudged
to be Major (4) or Catastrophic (5) regardless of likelihood in order to be assured that the
Controls that mitigate the risk remain sound.
A monthly Integrated Performance Report is submitted to the Board and the Quality and
Safety Committee detailing performance and quality information on activity, incidents,
staffing, CQUIN, and finance data. This is derived from the specialists with responsibility for
this data who also detail any accompanying explanatory text for exceptions.
The Board and directors are accountable for the establishment and ongoing delivery of
services within the requirements of the Provider Licence, risk assessment framework, and
maintained regulatory compliance, including against CQC ratings and feedback from
inspections leading up to achieving Foundation Trust status. The Quality and Safety
Committee and the Board receive monthly summaries, and any exceptions, of service
compliance with CQC Outcomes. Internally, directorates routinely undertake reviews of their
services against the CQC Outcomes and these are collated by the Head of Clinical
Governance, Quality and Effectiveness, monitored by the Chief Operating Officer and
escalated in report form to directors.
93
1. Strategic risks are those principal risks recorded on the BAF that may foreseeably impede
the ability of the organisation to deliver its objectives. These strategic principal risks
recorded on the BAF are carried over from its previous status as an NHS Trust to the end
of October 2014. Each of these retains Controls, Assurances and any gaps that are the
responsibility of an executive director. The Assurances are those documents received by the
Board. The strategic risk profile as at the end of March 2015 appears: • No Extreme Risks
• Two risks scoring High (12)
• Nine risks scoring High (8 to 10)
Two High (12) Strategic Risks: 14/15.5 Commercial competitiveness limited by failing to: • retain business
• gain new business
• respond adequately/in a timely manner to commissioning need
• respond to emerging opportunities
• adequately identify and engage appropriately with all strategic partners
14/15.18 Income loss: • Income loss
• Failure to maintain financial viability
• Reputational damage
These two risks are inherently linked and in order to mitigate these, the Trust has effective
‘early warning systems’ in place and a finance section in the Integrated Performance Report,
the Director of Finance monitors and signs off the pricing of services, a quarterly income risks
paper to Board, and there is an executive lead for each tender. The Board has also been in
receipt of an Annual Operating Plan, New Business Opportunities agenda item, and a
Commercial/Business Development Strategy.
14/15.1 A culture across all levels of the organisation that: • tolerates poor quality of service quality and provision
• fails to support and encourage staff
14/15.2 Substandard quality of care and service delivery due to: • failure adhere to best practice
• inadequate capacity and skills
• failure to adhere to agreed Trust policy and procedure
• failure to recognise or embed lessons learned from adverse events
14/15.4 Failure to adopt technology to improve quality and efficiency of healthcare
including: • mobile technology
• technological innovation
• telehealth
• electronic patient record
• single cross-borough Trust network platform
• an investment programme that takes into account CCG disinvestment
94
14/15.7 Financial/political initiatives affecting the health economy that influence
increasing demands without sufficiently matched income growth
14/15.8 Failure to consistently deliver services that meet contractual obligations: • Commissioning for Quality and Innovation (CQUIN) targets
• Care Quality indicators
• Specific KPI breaches
• agreed activity levels
• quality schedules
14/15.9 Failure to sustain and demonstrate long term financial viability: • poor forecasting of costs and to control expenditure
• failure to identify income streams and opportunities
• income fails to keep pace with increasing costs
With reference to strategic risk 14/15.9, the Trust experienced challenges in respect of its
financial forecasting, in the last quarter of 2014/15. Particular pressures arose from non-pay
items, including estate recharges, and agency expenditure. Going forward the Trust will need
to improve its forecasting capability, and the Trust has commissioned a review of its
processes in order to both identify areas for improvement and also to provide assurance for
2015/16.
14/14.10 Impact of the CIP programmes • Non-delivery or slippage on the delivery of CIPs
• Adverse influence of initiatives on quality of care
• Failure to demonstrate realisation of CIP savings
14/15.12 Failure to maintain and improve sound systems of governance and effective
internal control that: • offers clear and readily available escalation processes in a timely way
• provides relevant and adequate Board assurance
• offer sufficient quality assurance
• mitigates reputational regulatory, and commercial damage
• offer a proactive succession planning program
14/15.13 Inconsistent data between similar services across Boroughs: • Activity recording
• Data quality
• Technology issues
14/15.15 Failure to demonstrate benefits of organisational transition & structures,
specifically: • Matrix working
• Lines of escalation and communications
• Benefits realisation
• Combining operational control and relationship management
• Loss of commissioning legacy information
95
2. Operational risk: risks identified by operational staff and managers that may foreseeably
impede the safe delivery of high quality service to patients on a day to day basis. The
potential implication from this is that a high operational risk could adversely affect a service’s
ability to meet the organisational objectives.
Operational risks are identified, assessed, and documented at service level and monitored by
the Directorate Management Teams with any significant issues escalating to the Quality
management Group and the Quality and Safety Committee (with strategic risks) for
assurance.
The Operational Risk profile at the end of March 2015 comprises: • 2 Extreme Risks
• 61 High Risks
• 401 Moderate Risks
• 98 Low Risks
The Information Governance Team collates data from managers and Information Asset
Owners and maintains an Information Governance Toolkit and reports this to the Information
Governance Sub Group, and submits exceptions/risks to the Quality and Safety Committee.
Services maintain operational risk assessments for any foreseeable Information Governance
issues and report any Information Governance incidents on Ulysses. The Trust Caldicott
Guardian (Executive Nurse/Director of Governance) and the Senior Information Risk Owner
(Director of Finance) would be notified of any breaches of patient confidentiality that require
notification to the Information Commissioner. There were no significant Information
Governance incidents since inception as a Foundation Trust.
Governance
Directors oversaw all aspects of organisational performance and foreseeable risk, including
unprecedented challenges in achieving financial duties, ongoing financial viability, delivery
of Quality, Innovation, Productivity and Prevention (QIPP) initiatives, service pressures, and
maintaining key relationships and partnership working across the wider local health economy
and with Commissioners including engagement with Integrated Commissioning Plans and
transformation programmes.
For the financial reporting period 1st November 2014 to 31st March 2015, Bridgewater
Community Foundation NHS Trust has report a small surplus of £0.154m this is the same
figure as in the summarisation schedules that underpin the accounts.
The Trust had initially proposed an adjustment to the 2014/15 accounts amounting to £2.6m.
This represents the capital value of all wheelchair and other community loan assets owned by
the Trust, which have been purchased over a number of accounting periods. However, the
new accounting treatment in respect of such items will only apply to the FT accounts.
Therefore, only those costs incurred by the Trust in the five months from 1st November to
31st March 2015 may be properly capitalised.
Unfortunately, due to a variety of issues, the Trust did not meet the filing deadline of the 29th
May 2015 for Monitor.
A review of the circumstances and contributory issues in relation to the missed deadline is
being undertaken by the Trust together with an external review of the Trusts processes.
96
Throughout 2014/15 the Trust developed the Council of Governors in preparation for
Foundation Trust status, along with communication and engagement with the membership,
key stakeholders and other partners. Governors have been in attendance at Board meetings
and Quality and Safety Committee meetings for the presentation of information and
assurance regarding Bridgewater risks and incidents. Routine quality meetings, and also
performance meetings, are held with each of the Trusts commissioners (Clinical
Commissioning Groups or NHS England depending on the service) in order that they receive
assurance on service quality, risks, and are challenged on any exceptions are being
addressed.
Policies, Procedures, and Clinical Guidelines and associated staff training/implementation
are the most common form of Control for the majority of both Strategic and Operational risk.
The Policy Approval Group has delegated responsibility for establishing Policy development
guidelines, reviewing, and approving the Policies for the Trust. Built into the process for
Policy development, each document can only be approved once evidence of an Equality
Impact Assessment has been completed.
The Integrated Performance Report and the Quality Dashboard continue to be reviewed
regularly by Board and the Trust’s Senior Management Team (SMT) into November 2014
through March 2015. Each responsible Director reviews his/her component contribution and
these are triangulated to provide a holistic picture of outcomes and impact on service safety
and delivery, and the strategic objectives of the organisation.
Over the past three years the Board has observed a steady increase in incident reporting
that illustrates an increasing openness and honesty of staff to report incidents. With generic
access available to Trust staff, they may report anonymously if they wish. During 2014/15 the
Quality and Safety Committee noted a reduction in the overall volume of incidents compared
to the equivalent previous period, and that this was due to more frequent and detailed review
of incidents and more accurate reporting; the volume of Patient Safety Incident remained
constant.
There was an Escalation Framework that ensured Board members were briefed on any
significant events or risks between Board meetings. When this happened, Board members
received an email entitled ‘Flash Report’ from the Trust Secretary, with detail including the
nature of the issue, immediate remedial action, any likely media interest, long-term action,
and to which Board or committee meeting a formal report on the issue will be presented.
The Bridgewater Quality Strategy was developed to ensure the Trust has adequate processes and structures to provide a robust quality framework (monitored by the Quality and Safety
Committee) for delivery of safe, effective care which includes the sharing of best practice and
lessons learnt. This continued to be utilised from November 2014.
The Audit Committee oversees a programme of counter fraud arrangements, including the
contract with MIAA for a Counter Fraud Officer. An MIAA Internal Audit Plan was developed
and produced to address and ensure coverage of key risk areas of the Trust, with reference
to strategic risks identified within the BAF, management requests into areas of potential gaps
and weaknesses etc.
The foundation trust is fully compliant with the registration requirements of the Care Quality
Commission.
97
As an employer with staff entitled to membership of the NHS Pension Scheme, control
measures are in place to ensure all employer obligations contained within the Scheme
regulations are complied with. This includes ensuring that deductions from salary, employer’s
contributions and payments into the Scheme are in accordance with the Scheme rules, and
that member Pension Scheme records are accurately updated in accordance with the
timescales detailed in the Regulations.
Control measures are in place to ensure that all the organisation’s obligations under equality,
diversity and human rights legislation are complied with.
The foundation trust has undertaken risk assessments and Carbon Reduction Delivery Plans
are in place in accordance with emergency preparedness and civil contingency
requirements, as based on UKCIP 2009 weather projects, to ensure that this organisation’s
obligations under the Climate Change Act and the Adaptation Reporting requirements are
complied with.
Review of economy, efficiency and effectiveness of the use of resources
The Trust Efficiency Assurance Committee (TEAC) oversaw delivery of the Trust’s efficiency
programmes, and provided appropriate assurance directly to the Board that delivery was on
track and that the potential impact on services was adequately assessed.
Bridgewater had a robust process, monitored by the TEAC, which assessed the viability of,
and risks to, the Trust’s Cost Improvement Plans (CIP) both from a financial stand point and a
quality impact perspective.
Integral to the CIP was the rolling Quality Impact Assessment (QIA) programme, undertaken
by the Trust’s QIA panel at the beginning of each project (at project scope stage), at the
design stage, and immediately prior to sign off. If a scheme was foreseeably deemed to
have an adverse impact on quality or patient safety, then the sponsor was required to
address the concerns of the QIA panel and to resubmit for further assessment. If the panel’s
concerns prevailed, the scheme would be replaced with another scheme. Overall
responsibility for each project proceeding to implementation rested with the Executive
Medical Director and the Executive Nurse. The Quality and Safety Committee was in receipt
of quarterly QIA summaries for monitoring and assurance purposes. After the initial sign off
of a CIP initiative, there was an ongoing process in place to monitor the progress and
efficacy of the initiative on service quality and delivery.
Two High (12) Strategic Risks (14/15.5 and 14/15.18 earlier in this document) represent risks
to income and financial viability. These two risks are inherently linked and in order to mitigate
these, the Trust has effective ‘early warning systems’ in place and a finance section in the
Integrated Performance Report, the Director of Finance monitors and signs off the pricing of
services, a quarterly income risks paper to Board, and there is an executive lead for each
tender. The Board has also been in receipt of an Annual Operating Plan, New Business
Opportunities agenda item, and a Commercial/Business Development Strategy.
The Trust Caldicott Guardian (Executive Nurse/Director of Governance) and the Senior
Information Risk Owner (Director of Finance) would be notified of any breaches of patient
confidentiality that require notification to the Information Commissioner. There were no
significant Information Governance incidents since inception as a Foundation Trust.
98
Annual Quality Report
The directors are required under the Health Act 2009 and the National Health Service (Quality Accounts) Regulations 2010 (as amended) to prepare Quality Accounts for each financial
year. Monitor has issued guidance to NHS foundation trust boards on the form and content of
annual Quality Reports which incorporate the above legal requirements in the NHS
Foundation Trust Annual Reporting Manual.
The annual Quality Report has been developed in line with relevant national guidance. The
Trust has a dedicated Quality and Safety Committee chaired by a Non-Executive Director. All
data and information within the Quality Report is reviewed through this committee.
As a committee of the Board, the Quality and Safety Committee receives reports on safety
and quality, including the Integrated Performance Report on a monthly basis. The Integrated
Performance Report and the Quality Dashboard are also received directly by the Board.
Senior clinicians from the relevant services and specialist support officers have contributed
data and knowledge into the report. The quality report is reviewed through both internal and
external audit processes and comments have been provided by local stakeholders including
commissioners, patients and the local authority.
Review of effectiveness
As Accounting Officer, I have responsibility for reviewing the effectiveness of the system of
internal control. My review of the effectiveness of the system of internal control is informed by
the work of the internal auditors, clinical audit and the executive managers and clinical leads
within the NHS foundation trust who have responsibility for the development and
maintenance of the internal control framework. I have drawn on the content of the quality
report attached to this Annual report and other performance information available to me. My
review is also informed by comments made by the external auditors in their management
letter and other reports. I have been advised on the implications of the result of my review of
the effectiveness of the system of internal control by the board, the audit committee, and the
Quality and Safety Committee and a plan to address weaknesses and ensure continuous
improvement of the system is in place.
The Board considered its own performance as part of the Quality Governance (QGAF) and
Board Governance Assurance (BGAF) Frameworks in place prior to Foundation Trust status.
The Quality and Safety Committee and the Audit Committee both assessed their own
performance and effectiveness using Self-Assessment Questionnaires. The Trust continued
to comply with the HM Treasury/Cabinet Office Corporate Governance Code.
The Trust came under scrutiny by the Monitor team as part of its application for Foundation
Trust status, Professor Sir Mike Richards, Chief Inspector of Hospitals, said at the time:
“Overall, we found services provided by Bridgewater Community Healthcare
NHS Trust were safe, although there is need to improve systems for sharing
learning from incidents across the Trust as a whole.
“Most of the patients and carers we met described staff as caring and
compassionate and felt that services were responsive to people’s needs.
We noticed that staff worked well in multidisciplinary teams across
organisations to provide support to patients in the community.
99
“There was some evidence that waiting times could be longer than expected,
and this was a source of frustration for some patients. I am sure the Trust will
want to address that as a priority.”
The Chief Executive, supported by Directors, and with constructive critical challenge from
the Non-Executive Members of the Board, continued to receive information and monitor
plans and initiatives across the Trust during 2014/15 based on the solutions identified during
2013/14.
The Audit Committee has separate internal and external audit plans. The Committee meets
on a bi-monthly basis with representation from both internal and external audit functions. The
terms of reference have been reviewed in line with the Intelligent Board and Audit Committee
Handbook publications. An annual work plan is produced which dovetailed with the Board’s
calendar and continues from April 2014 into the period of Foundation Trust status. The Audit
Committee’s primary role is to conclude upon the adequacy and effective operation of the
organisation’s overall internal control system.
The main focus of an Audit Committee’s work is related to internal financial control matters,
the maintenance of proper accounting records, the reliability of financial information, and a
wider focus on the safety and quality of patient care. However, within Bridgewater the Audit
Committee also considers the findings of Clinical Audit across operational services. The
overall opinion from the Director of Audit was:
“Significant Assurance can be given that there is a generally sound system of
internal control designed to meet the organisation’s objectives, and that
controls are generally being applied consistently. However, some weaknesses
in the design or inconsistent application of controls put the achievement of particular
objectives at risk.”
Although Significant Assurance has been identified, a range of actions have been
developed to address risks identified in the audits and will be monitored by the Audit
Committee in 2015/16. Follow up reports were provided to the Audit Committee regularly to
confirm the Trusts actions and implementation of recommendations raised in Audit Reports.
An Internal Audit Plan was developed to address a set of specific concerns and potential
risks raised by management. In addition, the BAF is the key document which MIAA consider
when producing the Internal Audit Plan to ensure that they produce a risk-based Audit Plan
bespoke to the Trust. During 2014/15 the Internal Audit function reviewed the following areas
and offered: High Assurance: •Nil
Significant Assurance: • Emergency Preparedness Review
• General Ledger
• Income & Debtors
• Non-Pay Expenditure
• Treasury Management
100
•
•
•
•
•
•
SystemOne and IG Governance Arrangements
Recruitment Processes Follow Up
Serious Untoward Incidents Follow Up
New Domain Review
Information Governance Toolkit
Safeguarding Follow Up Review
Limited Assurance: • Telephony Review
• Data Consistency Phase I Review
• Network Infrastructure Review
• Financial Systems Technical Security Review
• School Nursing Service Review
• 20 Working Day Dental Target
• Specialised Services Governance Arrangements Review
• ESR (HR/Payroll) Review
Detailed action plans have been developed in response to all recommendations from the
MIAA reports, regardless of the overall level of assurance, and will be monitored by the
Audit Committee and on occasion by, the Quality and Safety Committee with follow up visits
planned by MIAA during 2015/16 to receive updates and assurance that these have been
addressed.
The Audit Committee was in receipt of full reports and progress reports on all of the audits
and recommendations during 2014/15.
The Quality and Safety Committee, with a Non-Executive Chair and with representation from
Clinical Audit, Internal Audit, Executive Nurse/Director of Governance, Finance, HR, and
support functions (Infection Control, Information Governance, Medicines Management etc.),
met monthly and considered assurance on operational risk, safety, and quality issues and
a monthly report from the Quality Management Group. The Chair of the Quality and Safety
Committee also attended the Quality Management Group to observe the robustness of this
meeting and the data that they received and discussed.
Conclusion
As Chief Operating Officer during the whole period that the previous Accounting Officer was
in post, I can confirm that I am fully aware and was involved in the governance and systems
of internal control in place prior to taking up my current role as Accounting Officer.
The systems of internal control remain sound in that they have been reviewed and appear
robust and are able to identify and escalate any significant issues speedily and appropriately
to the proper level.
Accountable Officer: Colin Scales (Chief Executive)
Organisation: Bridgewater Community Healthcare NHS Foundation Trust
Signature:
Date: 12 June 2015
101
8. Full Annual Accounts for the part year ended 31 March 2015
Accounts for the period from 1st November 2014 to 31 March 2015
Foreword to the accounts
These accounts, for the period ended 31 March 2015, have been prepared by Bridgewater
Community Healthcare NHS Foundation Trust in accordance with paragraphs 24 & 25 of
Schedule 7 within the National Health Service Act 2006.
Colin Scales
102
Audit opinion and report
Independent auditor’s report to the Council of Governors of Bridgewater Community
Healthcare NHS Foundation Trust
Our opinion on the financial statements is unmodified
In our opinion the financial statements:
• give a true and fair view of the state of the financial position of Bridgewater
Community Healthcare NHS Foundation Trust as at 31 March 2015 and of its income
and expenditure for the five month period ended 31 March 2015; and
• have been properly prepared in accordance with the NHS Foundation Trust Annual
Reporting Manual and the directions under paragraph 25(2) of Schedule 7 of the
National Health Service Act 2006.
Who we are reporting to
This report is made solely to the Council of Governors of Bridgewater Community Healthcare
NHS Foundation Trust, as a body, in accordance with paragraph 24(5) of Schedule 7 of the
National Health Service Act 2006. Our audit work has been undertaken so that we might
state to the Trust’s Council of Governors those matters we are required to state to them in
an auditor’s report and for no other purpose. To the fullest extent permitted by law, we do
not accept or assume responsibility to anyone other than the Trust and the Trust’s Council of
Governors as a body, for our audit work, for this report, or for the opinions we have formed.
What we have audited
We have audited the financial statements of Bridgewater Community Healthcare NHS
Foundation Trust (‘the Trust’) for the five month period ended 31 March 2015 which comprise
the statement of comprehensive income, the statement of financial position, the statement of
cash flows, the statement of changes in taxpayers’ equity and the related notes.
The financial reporting framework that has been applied in their preparation is the NHS
Foundation Trust Annual Reporting Manual issued by Monitor, the Independent Regulator of
NHS Foundation Trusts.
Our assessment of risk
In arriving at our opinions set out in this report, we highlight the following risks that are, in our
judgement, likely to be most important to users’ understanding of our audit.
Valuation of contract income from commissioning bodies and associated receivables
The risk: The Trust receives a large proportion of its income from commissioners of
healthcare services. It invoices its commissioners throughout the year for services provided,
and at the year-end estimates and accrues for activity not yet invoiced. Invoices for the final
quarter of the year are not finalised and agreed until after the year-end and after the deadline
for the production of the financial statements. There is therefore a risk that the income from
commissioners (and associated receivables) recognised in the financial statements may be
misstated. We identified the accounting for the contract arrangements with commissioning
bodies (in particular the consistency of the income with contract terms) as one of the risks
that had the greatest impact on our audit strategy.
103
Operating income 2014/15
Income from commissioners
Other income from activities
Other income
98%
Our response: Our audit work included, but was not restricted to, assessing the Trust’s
accounting policy for revenue recognition, understanding management’s processes to
recognise this income in accordance with the stated accounting policy, performing
walk-throughs of management’s key controls over income recognition (for example controls
over contract billing, pricing and agreement of contract variations) to assess whether they
were designed effectively and substantively testing the income and associated receivables.
Our substantive testing included:
• testing of recorded contract income amounts to signed contracts and agreed
variations;
• testing a sample of the contract variations to ensure they were accounted for
appropriately and are not in dispute; and
• testing of NHS debtors to after date receipts and supporting documentation.
The Trust’s accounting policy on revenue recognition is shown in note 1.1 to the financial
statements and its analysis of its total operating income is included in notes 3 and 4.
Our findings:
We did not identify any material errors in the valuation of income from commissioners from
our testing, but we noted some non-trivial misstatements which we have reported to Those
Charged with Governance at the Trust (the Audit Committee) in our Audit Findings Report.
Management have decided to correct the majority of these misstatements, but provided us
with a written response to confirm why they had decided not to amend the financial
statements for one of the non-trivial misstatements. We have confirmed with the Audit
Committee that they agree with management that, because of the immaterial impact, no
adjustment need be made.
104
Completeness of employee remuneration and operating expenses and associated payables
The risk: The majority of the Trust’s expenditure relates to employee remuneration and operating
expenses. Together they account for 99% of the Trust’s gross expenditure. The Trust pays the majority
of this expenditure through its payroll and accounts payable systems and at the year-end estimates
and accrues for un-invoiced expenses. Invoices for the final weeks of the year are not received and
processed until after the year-end and in many cases after the deadline for the production of the
financial statements. There is therefore a risk that the expenses (and associated payables) recognised
in the financial statements may be misstated. We identified the completeness of employee
remuneration and operating expenses (in particular the understatement of accruals) as risks that had
the greatest impact on our audit strategy.
Expenditure 2014/15
Depreciation and impairment 1%
Other operating expenses
Employee
remuneration
69%
Other operating
expenses
30%
Drugs
Supplies and services
Our response: Our audit work included, but was not restricted to, understanding
management’s processes to recognise payroll and accounts payable expenditure and
year-end accruals for unprocessed invoices and expenditure incurred and not yet invoiced
(GRNI), walking through management’s key controls over recognition of expenditure (for
example, processing of adjustments and authorisation of payments) to assess whether they
were designed effectively and substantively testing expenditure and associated payables.
Our substantive testing included:
• testing the reconciliation of employee remuneration expenditure in the financial
statements to the general ledger and payroll subsystems;
• performing a trend analysis of payroll costs to identify any unusual cost variations for
follow up;
• sample testing payroll expenditure to source documents;
• assessing whether the Trust’s processes for accruing for GRNIs were sufficiently
robust to ensure that uninvoiced expenditure had been accrued for appropriately;
• sample testing accruals to post year-end invoices; and
• testing a sample of post year-end payments to confirm the completeness of accruals.
105
The Trust’s accounting policy for recognition of expenditure is shown in note 1, its analysis
of employee remuneration costs is included in note 7 and its analysis of operating costs is
included in note 5 to the financial statements.
Our findings:
We did not identify any material errors in the completeness of the employee remuneration
from our testing, but we identified one non-trivial misstatement in respect of this expenditure
which we have reported to the Audit Committee in our Audit Findings Report. Management
provided us with a written response to confirm why they have decided not to amend the
financial statements for this non-trivial misstatement. We have confirmed with the Audit
Committee that they agree with management that, because of the immaterial impact, no
adjustment need be made.
We identified a material error and some non-trivial misstatements in the completeness of
operating expenses from our testing which we have reported to the Audit Committee in our
Audit Findings Report. Management agreed to amend the financial statements to correct the
material error and all but one of these non-trivial misstatements. Management provided us
with a written response to confirm why they have decided not to amend the financial
statements for the non-trivial misstatement. We have confirmed with the Audit Committee
that they agree with management that, because of the immaterial impact, no adjustment
need be made.
Our application of materiality and an overview of the scope of our audit Materiality
We define materiality as the magnitude of misstatement in the financial statements that
makes it probable that the judgement of a reasonably knowledgeable person would be
changed or influenced.
We determined materiality for the audit of the financial statements as a whole to be
£1,142,000, which is 2% of the Trust’s gross operating costs. This benchmark is considered
the most appropriate because users of the financial statements are particularly interested in
how healthcare funding has been spent. We use a different level of materiality, performance
materiality, to drive the extent of our testing and this was set at 75% of financial statement
materiality. We also determine a lower level of specific materiality for certain areas such as
senior officer remuneration.
We determined the threshold at which we will communicate misstatements to the Trust’s
Audit Committee to be £57,000. In addition we communicate misstatements below that
threshold that, in our view, warrant reporting on qualitative grounds.
Overview of the scope of our audit
We conducted our audit in accordance with International Standards on Auditing (ISAs) (UK
and Ireland) having regard to the Financial Reporting Council’s Practice Note 10 ‘Audit of
Financial Statements of Public Bodies in the UK (Revised)’. Our responsibilities under the
Code and the ISAs (UK and Ireland) are further described in the ‘Responsibilities for the
financial statements and the audit’ section of our report. We believe that the audit evidence
we have obtained from our audit is sufficient and appropriate to provide a basis for our
opinion.
106
We are independent of the Trust in accordance with the Auditing Practices Board’s Ethical
Standards for Auditors, and we have fulfilled our other ethical responsibilities in accordance
with those Ethical Standards.
Our audit approach was based on a thorough understanding of the Trust’s business and
is risk based. The Trust’s payroll service is provided by a third party. Accordingly, our audit
work was focused on obtaining an understanding of, and evaluating, relevant internal
controls at both the Trust and its third party service provider.
Allocation of audit fieldwork time
Annual report
Accounting policies
and other disclosures
Income from activities
Journal entries
Operating expenses
Other
statements
Employee remuneration
Public dividend capital
and reserves
Other net current assets
Cash and borrowings
Other income andcosts
Inventories
Non current assets
We undertook substantive testing on significant transactions, balances and disclosures in the
financial statements, the extent of which was based on various factors such as our
overall assessment of the Trust’s control environment, the design effectiveness of controls
over significant financial systems and the management of risks.
Other reporting required by regulations
Our opinion on other matters prescribed by the Audit Code for NHS Foundation
Trusts is unmodified
In our opinion:
• the part of the Directors’ Remuneration Report subject to audit has been properly
prepared in accordance with the NHS Foundation Trust Annual Reporting Manual
2014-15 issued by Monitor; and
• the information given in the strategic report and directors’ report for the five month
financial period for which the financial statements are prepared is consistent with the
financial statements.
107
Matters on which we are required to report by exception
We have nothing to report in respect of the following:
Under the Code we are required to report to you if, in our opinion:
• the Annual Governance Statement does not meet the disclosure requirements
set out in the NHS Foundation Trust Annual Reporting Manual or is misleading or
inconsistent with the information of which we are aware from our audit;
• we have not been able to satisfy ourselves that the Trust has made proper
arrangements for securing economy, efficiency and effectiveness in its use of
resources; or
• the Trust’s Quality Report has not been prepared in line with the requirements set
out in Monitor’s published guidance or is inconsistent with other sources of
evidence.
Under the ISAs (UK and Ireland), we are also required to report to you if, in our opinion,
information in the annual report is:
•
•
•
materially inconsistent with the information in the audited financial statements; or
apparently materially incorrect based on, or materially inconsistent with, our
knowledge of the Trust acquired in the course of performing our audit; or
otherwise misleading.
In particular, we are required to report to you if:
• we have identified any inconsistencies between our knowledge acquired during the
audit and the directors’ statement that they consider the annual report is fair,
balanced and understandable; or
• the annual report does not appropriately disclose those matters that were
communicated to the Audit Committee which we consider should have been
disclosed.
Responsibilities for the financial statements and the audit
What an audit of financial statements involves:
An audit involves obtaining evidence about the amounts and disclosures in the financial
statements sufficient to give reasonable assurance that the financial statements are free from
material misstatement, whether caused by fraud or error. This includes an assessment of:
whether the accounting policies are appropriate to the Trust’s circumstances and have been
consistently applied and adequately disclosed; the reasonableness of significant
accounting estimates made by the Trust; and the overall presentation of the financial
statements. In addition, we read all the financial and non-financial information in the annual
report to identify material inconsistencies with the audited financial statements and to identify
any information that is apparently materially inconsistent with the knowledge acquired by us
in the course of performing the audit. If we become aware of any apparent material
misstatements or inconsistencies we consider the implications for our report.
What the Chief Executive is responsible for as accounting officer:
As explained more fully in the Chief Executive’s Responsibilities Statement, the Chief
Executive as Accounting Officer is responsible for the preparation of the financial statements
in the form and on the basis set out in the Accounts Direction issued by Monitor and for
being satisfied that they give a true and fair view.
108
What are we responsible for:
Our responsibility is to audit and express an opinion on the financial statements in
accordance with applicable law, the Audit Code for NHS Foundation Trusts issued by
Monitor, and ISAs (UK and Ireland). Those standards require us to comply with the Auditing
Practices Board’s Ethical Standards for Auditors.
Certificate
We certify that we have completed the audit of the financial statements of Bridgewater
Community Healthcare NHS Foundation Trust in accordance with the requirements of
Chapter 5 of Part 2 of the National Health Service Act 2006 and the Audit Code for NHS
Foundation Trusts issued by Monitor.
Mark Heap
Director
for and on behalf of Grant Thornton UK LLP
4 Hardman Square Spinningfields MANCHESTER
M3 3EB
June 2015
109
Colin Scales
Chief Executive
Statement
Comprehensive
Statement of of
Comprehensive
Income Income
Operating income from patient care activities
Other operating income
Total operating income from continuing operations
Operating expenses
Operating surplus/(deficit) from continuing operations
Finance income
Finance expenses
PDC dividends payable
Net finance costs
Note
3
4
5, 7
2014-15:
For the 5
months
ending 31
March
2015
£000
62,045
1,021
63,066
(62,733)
333
10
8
(187)
(179)
Surplus/(deficit) for the year from continuing operations
154
Other comprehensive income
Will not be reclassified to income and expenditure:
Revaluations
Total other comprehensive income/(expense) for the
14
360
360
period
period
Total
Total comprehensive
comprehensive income/(expense)
income/(expense) for
for the
the period
period
514
514
Allocation
Allocation of
of profits
profits for
for the
the period:
period:
Surplus
Surplus for
for the
the period
period attributable
attributable to
to owners
owners of
of the
the
parent
parent
154
154
Total
Total comprehensive
comprehensive income
income for
for the
the period
period attributable
attributable to
to
owners
of
the
parent
owners of the parent
514
514
Statement
Statement of
of Financial
Financial Position
Position
Non-current
Non-current assets
assets
Intangible
Intangible assets
assets
Property,
Property, plant
plant and
and equipment
equipment
Trade
and
other
Trade and other
receivables
receivables
Total
Total non-current
non-current
assets
assets
Current
Current assets
assets
Inventories
Inventories
Bridgewater
Annual Report 2014/15
110
Trade
Trade and
and other
other
receivables
receivables
Cash
Cash and
and cash
cash
31
31 March
March
2015
2015
£000
£000
Opening
Opening
Position
Position
11 November
November
2014
2014
£000
£000
13
13
14
14
108
108
22,575
22,575
128
128
17,386
17,386
19
19
640
640
686
686
23,323
23,323
18,200
18,200
18
18
39
39
952
952
19
19
10,038
10,038
11,746
11,746
Note
Note
Total comprehensive income for the period attributable to
owners of the parent
514
Statement
Financial
Position
Statement ofof
Financial
Position
Non-current assets
Intangible assets
Property, plant and equipment
Trade and other
receivables
Total non-current
assets
Current assets
Inventories
Trade and other
receivables
Cash and cash
equivalents
Total current assets
Current liabilities
Trade and other
payables
Provisions
Total current liabilities
Total assets less current liabilities
Non-current liabilities
Trade and other
payables
Other liabilities
Borrowings
Other financial
liabilities
Provisions
Total non-current
31 March
2015
£000
Opening
Position
1 November
2014
£000
13
14
108
22,575
128
17,386
19
640
686
23,323
18,200
18
39
952
19
10,038
11,746
23
5,861
15,938
5,349
18,047
24
29
(16,431)
(34)
(16,465)
22,796
(16,784)
(47)
(16,831)
19,416
24
26
27
-
-
25
29
-
-
Note
Page 104
liabilities
Total assets employed
22,796
19,416
Financed by
Revaluation reserve
Income and expenditure reserve
Total taxpayers' equity
4,962
4,814
13,020
22,796
4,121
4,454
10,841
19,416
The notes on pages 25 to 62 form part of these
accounts.
Colin Scales
Chief Executive
Date
12 June 2015
Public
Income2014/15
and
Bridgewater Annual Report
dividend Revaluation expenditure
capital
reserve
reserve
£000
£000
£000
111
Total
£000
liabilities
Total assets employed
22,796
19,416
Financed by
Revaluation reserve
Total taxpayers' equity
4,962
4,814
13,020
22,796
4,121
4,454
10,841
19,416
The
form part
part of
Thenotes
noteson
onpages
pages114
25 to
to 148
62 form
ofthese
these
accounts
accounts.
Colin Scales
Chief Executive
Date
12 June 2015
Public
Income and
dividend Revaluation expenditure
capital
reserve
reserve
£000
£000
£000
Taxpayers equity at 1 November 2014 - brought
forward
Opening adjustment
Surplus/(deficit) for the year
Revaluations
Public dividend capital received
Taxpayers equity at 31 March 2015
4,121
4,454
841
4,962
360
4,814
10,841
2,025
154
13,020
Total
£000
19,416
2,025
154
360
841
22,796
Information on reserves
Information on reserves
Public dividend
capital
(PDC) is a type of public sector equity finance based on the excess of assets over
Public
dividend
capital
liabilities at the time of establishment of the predecessor NHS trust. Additional PDC may also be issued to
Public dividend capital (PDC) is a type of public sector equity finance based on the excess
NHS foundation trusts by the Department of Health. A charge, reflecting the cost of capital utilised by the
of
assets over liabilities at the time of establishment of the predecessor NHS trust. Additional
NHS foundation trust, is payable to the Department of Health as the public dividend capital dividend.
PDC may also be issued to NHS foundation trusts by the Department of Health. A charge,
reflecting
cost of capital utilised by the NHS foundation trust, is payable to the
Revaluationthe
reserve
Department
of
as thefrom
public
dividendare
capital
dividend.
Increases in assetHealth
values arising
revaluations
recognised
in the revaluation reserve, except
where, and to the extent that, they reverse impairments previously recognised in operating expenses, in
which case theyreserve
are recognised in operating income. Subsequent downward movements in asset
Revaluation
valuations are charged to the revaluation reserve to the extent that a previous gain was recognised
Increases
in asset values
arising
from revaluations
are recognised
the revaluation
reserve,
unless the downward
movement
represents
a clear consumption
of economicin
benefit
or a reduction
in
except
where, and to the extent that, they reverse impairments previously recognised in
service potential.
operating expenses, in which case they are recognised in operating income. Subsequent
downward
movementsreserve
in asset valuations are charged to the revaluation reserve to the extent
Income and expenditure
that a previous gain was recognised unless the downward movement represents a clear
Page 105
consumption of economic benefit or a reduction in service potential.
112
The balance of this reserve is the accumulated surpluses and deficits of the NHS foundation
trust.
The balance
of this
reserve is of
the£2,025k
accumulated
surpluses
and deficits
of the NHS foundation
trust.
The
opening
adjustment
reflects
the change
in accounting
policy disclosed
at
The opening
adjustment
£2,025k reflectsof
the
change in accounting
policy
disclosed
at note
1.4 with regard to
note
1.4 with
regard toofcapitalisation
wheelchair
and home
loans
supplies
as Property
capitalisation
Plant
and Equipment. This change in accounting policy also refle SoFP and related notes as
of wheelchair and
home loans supplies as Property Plant and Equipment. This change in accounting policy also reflects the
summarised
below:
SoFP
and related notes as summarised below:
• Property, plant and equipment - £2,946k debit (increase)
• Inventory
£921k credit
(decrease)
- Property,
plant and- equipment
- £2,946k
debit (increase)
• Income
Expenditure
- Inventory
- £921kand
credit
(decrease) Reserve - £2,025k credit (increase)
- Income and Expenditure Reserve - £2,025k credit (increase)
Statement
Cash
Statement
of of
Cash
FlowsFlows
Cash flows from operating activities
Operating surplus/(deficit)
Non-cash income and expense:
Depreciation and amortisation
(Increase)/decrease in receivables and other assets
(Increase)/decrease in inventories
Increase/(decrease) in payables and other liabilities
Increase/(decrease) in provisions
Net cash generated from/(used in) operating activities
Cash flows from investing activities
Interest received
Purchase of property, plant, equipment and investment
property
Net cash generated from/(used in) investing activities
Cash flows from financing activities
Public dividend capital received
PDC dividend paid
Net cash generated from/(used in) financing activities
Increase/(decrease) in cash and cash equivalents
Cash and cash equivalents at 01 November
Cash and cash equivalents at 31 March
2014-15:
For the 5
months
ending 31
March
2015
Note
£000
333
5
643
1,754
(8)
(1,166)
(13)
1,543
8
(1,655)
(1,647)
23
841
(225)
616
512
5,349
5,861
Note 1 Accounting policies and other information
Basis of preparation
Page 106
113
Note 1 Accounting policies and other information
Basis of preparation
Monitor has directed that the financial statements of NHS foundation trusts shall meet the
accounting requirements of the FT ARM which shall be agreed with HM Treasury.
Consequently, the following financial statements have been prepared in accordance with the
FT ARM 2014/15 issued by Monitor. The accounting policies contained in that manual follow
IFRS and HM Treasury’s FReM to the extent that they are meaningful and appropriate to NHS
foundation trusts. The accounting policies have been applied consistently in dealing with
items considered material in relation to the accounts.
Accounting convention
These accounts have been prepared under the historical cost convention modified to
account for the revaluation of property, plant and equipment, intangible assets, inventories
and certain financial assets and financial liabilities.
Going concern
These accounts have been prepared on a going concern basis.
Note 1.1 Income
Income in respect of services provided is recognised when, and to the extent that,
performance occurs and is measured at the fair value of the consideration receivable. The
main source of income for the trust is contracts with commissioners in respect of health care
services.
Where income is received for a specific activity which is to be delivered in a subsequent
financial year, that income is deferred.
Income from the sale of non-current assets is recognised only when all material conditions of
sale have been met, and is measured as the sums due under the sale contract.
The Trust receives income under the NHS Injury Cost Recovery Scheme, designed to reclaim
the cost of treating injured individuals to whom personal injury compensation has
subsequently been paid e.g. by an insurer. The Trust recognises the income when it receives
notification from the Department of Work and Pension’s Compensation Recovery Unit that
the individual has lodged a compensation claim. The income is measured at the agreed tariff
for the treatments provided to the injured individual, less a provision for unsuccessful
compensation claims and doubtful debts.
Note 1.2 Expenditure on employee benefits
Short-term employee benefits
Salaries, wages and employment-related payments are recognised in the period in which
the service is received from employees. The cost of annual leave entitlement earned but not
taken by employees at the end of the period is recognised in the financial statements to the
extent that employees are permitted to carry-forward leave into the following period.
114
Pension costs
NHS Pension Scheme
Past and present employees are covered by the provisions of the NHS Pension Scheme. The
scheme is an unfunded, defined benefit scheme that covers NHS employers, general
practices and other bodies, allowed under the direction of Secretary of State, in England and
Wales. It is not possible for the NHS foundation trust to identify its share of the underlying
scheme liabilities. Therefore, the scheme is accounted for as a defined contribution scheme.
Employers pension cost contributions are charged to operating expenses as and when they
become due.
Additional pension liabilities arising from early retirements are not funded by the scheme
except where the retirement is due to ill-health. The full amount of the liability for the
additional costs is charged to the operating expenses at the time the trust commits itself to
the retirement, regardless of the method of payment.
Note 1.3 Expenditure on other goods and services
Expenditure on goods and services is recognised when, and to the extent that they have
been received, and is measured at the fair value of those goods and services. Expenditure is
recognised in operating expenses except where it results in the creation of a non- current
asset such as property, plant and equipment.
Note 1.4 Property, plant and equipment
Recognition
Property, plant and equipment is capitalised where:
• it is held for use in delivering services or for administrative purposes;
• it is probable that future economic benefits will flow to, or service potential be provided
to, the trust;
• it is expected to be used for more than one financial year; and
• the cost of the item can be measured reliably
• the item has cost more than £5,000
• items are/to be issued in the community, with specific reference to Wheelchair and
Home Loans Community services, where the individual item cost is at least £250. The
decision to treat these assets as PPE rather than inventory is considered to be a
critical accounting judgement.
• collectively, a number of items have a cost of at least £5,000 and individually have a
cost of more than £250, where the assets are functionally interdependent, they had
broadly simultaneous purchase dates, are anticipated to have simultaneous disposal
dates and are under single managerial control; or
• items form part of the initial equipping and setting-up cost of a new building, ward or
unit, irrespective of their individual or collective cost.
Where a large asset, for example a building, includes a number of components with
significantly different asset lives, eg, plant and equipment, then these components are
treated as separate assets and depreciated over their own useful economic lives.
115
Measurement
Valuation
All property, plant and equipment assets are measured initially at cost, representing the costs
directly attributable to acquiring or constructing the asset and bringing it to the location and
condition necessary for it to be capable of operating in the manner intended by management.
All assets are measured subsequently at fair value. Land and buildings used for the Trust’s
services or for administrative purposes are stated in the statement of financial position at their
revalued amounts, being the fair value at the date of revaluation less any impairment.
For equipment within Wheelchairs and Homeloans on issue the Trust has adopted a
depreciated historical cost basis as a proxy for fair value in respect of these low value/short
life assets.
Revaluations are performed with sufficient regularity to ensure that carrying amounts are not
materially different from those that would be determined at the end of the reporting period.
Fair values are determined as follows:
• Land and non-specialised buildings - market value of existing use
• Specialised buildings - depreciated replacement cost
Subsequent expenditure
Subsequent expenditure relating to an item of property, plant and equipment is recognised
as an increase in the carrying amount of the asset when it is probable that additional future
economic benefits or service potential deriving from the cost incurred to replace a
component of such item will flow to the enterprise and the cost of the item can be determined
reliably. Where a component of an asset is replaced, the cost of the replacement is
capitalised if it meets the criteria for recognition above. The carrying amount of the part
replaced is de-recognised. Other expenditure that does not generate additional future
economic benefits or service potential, such as repairs and maintenance, is charged to the
Statement of Comprehensive Income in the period in which it is incurred.
Depreciation
Items of property, plant and equipment are depreciated over their remaining useful economic
lives in a manner consistent with the consumption of economic or service delivery benefits.
Freehold land is considered to have an infinite life and is not depreciated.
Property, plant and equipment which has been reclassified as ‘held for sale’ ceases to be
depreciated upon the reclassification. Assets in the course of construction and residual
interests in off-Statement of Financial Position PFI contract assets are not depreciated until
the asset is brought into use or reverts to the trust, respectively.
Revaluation gains and losses
Revaluation gains are recognised in the revaluation reserve, except where, and to the extent
that, they reverse a revaluation decrease that has previously been recognised in operating
expenses, in which case they are recognised in operating income.
116
Revaluation losses are charged to the revaluation reserve to the extent that there is an
available balance for the asset concerned, and thereafter are charged to operating expenses.
Gains and losses recognised in the revaluation reserve are reported in the Statement of
Comprehensive Income as an item of ‘other comprehensive income’.
Impairments
In accordance with the FT ARM, impairments that arise from a clear consumption of
economic benefits or of service potential in the asset are charged to operating expenses. A
compensating transfer is made from the revaluation reserve to the income and expenditure
reserve of an amount equal to the lower of (i) the impairment charged to operating expenses;
and (ii) the balance in the revaluation reserve attributable to that asset before the impairment.
An impairment that arises from a clear consumption of economic benefit or of service
potential is reversed when, and to the extent that, the circumstances that gave rise to the
loss is reversed. Reversals are recognised in operating income to the extent that the asset is
restored to the carrying amount it would have had if the impairment had never been
recognised. Any remaining reversal is recognised in the revaluation reserve. Where, at the
time of the original impairment, a transfer was made from the revaluation reserve to the
income and expenditure reserve, an amount is transferred back to the revaluation reserve
when the impairment reversal is recognised.
Other impairments are treated as revaluation losses. Reversals of ‘other impairments’ are
treated as revaluation gains.
De-recognition
Assets intended for disposal are reclassified as ‘held for sale’ once all of the following criteria
are met:
• the asset is available for immediate sale in its present condition subject only to terms
which are usual and customary for such sales;
• the sale must be highly probable ie:
• management are committed to a plan to sell the asset;
• an active programme has begun to find a buyer and complete the sale;
• the asset is being actively marketed at a reasonable price;
• the sale is expected to be completed within 12 months of the date of classification
as ‘held for sale’; and
• the actions needed to complete the plan indicate it is unlikely that the plan will be
dropped or significant changes made to it.
Following reclassification, the assets are measured at the lower of their existing carrying
amount and their ‘fair value less costs to sell’. Depreciation ceases to be charged. Assets are
de-recognised when all material sale contract conditions have been met.
Property, plant and equipment which is to be scrapped or demolished does not qualify for
recognition as ‘held for sale’ and instead is retained as an operational asset and the asset’s
economic life is adjusted. The asset is de-recognised when scrapping or demolition occurs.
117
Donated, government grant and other grant funded assets
Donated and grant funded property, plant and equipment assets are capitalised at their fair
value on receipt. The donation/grant is credited to income at the same time, unless the donor
has imposed a condition that the future economic benefits embodied in the grant are to be
consumed in a manner specified by the donor, in which case, the donation/grant is deferred
within liabilities and is carried forward to future financial years to the extent that the condition
has not yet been met.
The donated and grant funded assets are subsequently accounted for in the same manner
as other items of property, plant and equipment.
Private Finance Initiative (PFI) transactions
PFI transactions which meet the IFRIC 12 definition of a service concession, as interpreted in
HM Treasury’s FReM, are accounted for as ‘on-Statement of Financial Position’ by the trust.
The Trust has not entered into any PFI transactions
Useful Economic lives of property, plant and equipment
Useful economic lives reflect the total life of an asset and not the remaining life of an asset.
The range of useful economic lives are shown in the table below:
Land
Buildings, excluding dwellings
Dwellings
Assets under construction
Plant & machinery
Transport equipment
Information technology
Furniture & fittings
Wheelchairs/home loans equipment
Min life Years
5
1
1
1
1
Max life Years
88
10
5
5
5
Finance-leased assets (including land) are depreciated over the shorter of the useful
economic life or the lease term, unless the FT expects to acquire the asset at the end of the
lease term in which case the assets are depreciated in the same manner as owned assets
above.
Note 1.5 Intangible assets
Recognition
Intangible assets are non-monetary assets without physical substance which are capable of
being sold separately from the rest of the trust’s business or which arise from contractual or
other legal rights. They are recognised only where it is probable that future economic benefits
will flow to, or service potential be provided to, the trust and where the cost of the asset can
be measured reliably.
118
Internally generated intangible assets
Internally generated goodwill, brands, mastheads, publishing titles, customer lists and similar
items are not capitalised as intangible assets.
Expenditure on research is not capitalised.
Expenditure on development is capitalised only where all of the following can be
demonstrated:
• the project is technically feasible to the point of completion and will result in an
intangible asset for sale or use;
• the trust intends to complete the asset and sell or use it;
• the trust has the ability to sell or use the asset;
• how the intangible asset will generate probable future economic or service delivery
benefits, eg, the presence of a market for it or its output, or where it is to be used for
internal use, the usefulness of the asset;
• adequate financial, technical and other resources are available to the trust to
complete the development and sell or use the asset; and
• the trust can measure reliably the expenses attributable to the asset during
development.
Software
Software which is integral to the operation of hardware, eg an operating system, is
capitalised as part of the relevant item of property, plant and equipment. Software which is
not integral to the operation of hardware, eg application software, is capitalised as an
intangible asset.
Measurement
Intangible assets are recognised initially at cost, comprising all directly attributable costs
needed to create, produce and prepare the asset to the point that it is capable of operating
in the manner intended by management.
Subsequently intangible assets are measured at fair value. Revaluations gains and losses
and impairments are treated in the same manner as for property, plant and equipment.
Intangible assets held for sale are measured at the lower of their carrying amount or “fair
value less costs to sell”.
Amortisation
Intangible assets are amortised over their expected useful economic lives in a manner
consistent with the consumption of economic or service delivery benefits.
119
Useful economic life of intangible assets
Useful economic lives reflect the total life of an asset and not the remaining life of an asset.
The range of useful economic lives are shown in the table below:
Intangible assets - internally generated
Information technology
Development expenditure
Other
Intangible assets - purchased
Software
Licences & trademarks
Patents
Other
Goodwill
Min life Years
1
-
Max life Years
5
-
-
-
Note 1.6 Revenue government and other grants
Government grants are grants from Government bodies other than income from
commissioners or NHS trusts for the provision of services. Where a grant is used to fund
revenue expenditure it is taken to the Statement of Comprehensive Income to match that
expenditure.
Note 1.7 Inventories
Inventories are valued at the lower of cost and net realisable value. The cost of inventories
is measured using the first -in first-out cost formula. This is considered to be a reasonable
approximation to fair value due to the high turnover of stocks
Note 1.8 Financial instruments and financial liabilities
Recognition
Financial assets and financial liabilities which arise from contracts for the purchase or sale of
non-financial items (such as goods or services), which are entered into in accordance with
the trust’s normal purchase, sale or usage requirements, are recognised when, and to the
extent which, performance occurs, ie, when receipt or delivery of the goods or services is
made.
De-recognition
All financial assets are de-recognised when the rights to receive cash flows from the assets
have expired or the trust has transferred substantially all of the risks and rewards of
ownership.
Financial liabilities are de-recognised when the obligation is discharged, cancelled or expires.
Classification and measurement
Financial assets are categorised as “loans and receivables”. Financial liabilities are classified
as “other financial liabilities”
120
Loans and receivables
Loans and receivables are non-derivative financial assets with fixed or determinable
payments which are not quoted in an active market. They are included in current assets.
The trust’s loans and receivables comprise: cash and cash equivalents and trade and other
receivables excluding non financial assets.
Loans and receivables are recognised initially at fair value, net of transactions costs, and are
measured subsequently at amortised cost, using the effective interest method. The
effective interest rate is the rate that discounts exactly estimated future cash receipts through
the expected life of the financial asset or, when appropriate, a shorter period, to the net
carrying amount of the financial asset.
Interest on loans and receivables is calculated using the effective interest method and
credited to the Statement of Comprehensive Income.
Other financial liabilities
All other financial liabilities are recognised initially at fair value, net of transaction costs
incurred, and measured subsequently at amortised cost using the effective interest method.
The effective interest rate is the rate that discounts exactly estimated future cash payments
through the expected life of the financial liability or, when appropriate, a shorter period, to the
net carrying amount of the financial liability.
They are included in current liabilities except for amounts payable more than 12 months after
the Statement of Financial Position date, which are classified as long-term liabilities.
Interest on financial liabilities carried at amortised cost is calculated using the effective
interest method and charged to finance costs. Interest on financial liabilities taken out to
finance property, plant and equipment or intangible assets is not capitalised as part of the
cost of those assets.
Determination of fair value
For financial assets and financial liabilities carried at fair value, the carrying amounts are
determined from quoted market prices, independent appraisals and discounted cash flow
analysis
Impairment of financial assets
At the Statement of Financial Position date, the trust assesses whether any financial assets,
other than those held at “fair value through income and expenditure” are impaired. Financial
assets are impaired and impairment losses are recognised if, and only if, there is objective
evidence of impairment as a result of one or more events which occurred after the initial
recognition of the asset and which has an impact on the estimated future cash flows of the
asset.
For financial assets carried at amortised cost, the amount of the impairment loss is measured
as the difference between the asset’s carrying amount and the present value of the revised
future cash flows discounted at the asset’s original effective interest rate. The loss is
recognised in the Statement of Comprehensive Income and the carrying amount of the asset
is reduced directly.
121
Note 1.9 Leases
Finance leases
Where substantially all risks and rewards of ownership of a leased asset are borne by the
NHS foundation trust, the asset is recorded as property, plant and equipment and a
corresponding liability is recorded. The value at which both are recognised is the lower of the
fair value of the asset or the present value of the minimum lease payments, discounted using
the interest rate implicit in the lease.
The asset and liability are recognised at the commencement of the lease. Thereafter the
asset is accounted for an item of property plant and equipment.
The annual rental is split between the repayment of the liability and a finance cost so as
to achieve a constant rate of finance over the life of the lease. The annual finance cost is
charged to Finance Costs in the Statement of Comprehensive Income. The lease liability, is
de-recognised when the liability is discharged, cancelled or expires.
Operating leases
Other leases are regarded as operating leases and the rentals are charged to operating
expenses on a straight-line basis over the term of the lease. Operating lease incentives
received are added to the lease rentals and charged to operating expenses over the life of
the lease.
Leases of land and buildings
Where a lease is for land and buildings, the land component is separated from the building
component and the classification for each is assessed separately.
Note 1.10 Provisions
The NHS foundation trust recognises a provision where it has a present legal or constructive
obligation of uncertain timing or amount; for which it is probable that there will be a future
outflow of cash or other resources; and a reliable estimate can be made of the amount. The
amount recognised in the Statement of Financial Position is the best estimate of the
resources required to settle the obligation. Where the effect of the time value of money is
significant, the estimated risk-adjusted cash flows are discounted using the discount rates
published and mandated by HM Treasury.
Clinical negligence costs
The NHS Litigation Authority (NHSLA) operates a risk pooling scheme under which the NHS
foundation trust pays an annual contribution to the NHSLA, which, in return, settles all
clinical negligence claims. Although the NHSLA is administratively responsible for all clinical
negligence cases, the legal liability remains with the NHS foundation trust. The total value of
clinical negligence provisions carried by the NHSLA on behalf of the NHS foundation trust is
disclosed at note 30 but is not recognised in the NHS foundation trust’s accounts.
Non-clinical risk pooling
The NHS foundation trust participates in the Property Expenses Scheme and the Liabilities to
Third Parties Scheme. Both are risk pooling schemes under which the trust pays an annual
contribution to the NHS Litigation Authority and in return receives assistance with the costs of
122
claims arising. The annual membership contributions, and any “excesses” payable in respect
of particular claims are charged to operating expenses when the liability arises.
Note 1.11 Contingencies
Contingent assets (that is, assets arising from past events whose existence will only be
confirmed by one or more future events not wholly within the entity’s control) are not
recognised as assets, but are disclosed in note 30 where an inflow of economic benefits is
probable.
Contingent liabilities are not recognised, but are disclosed in note 30, unless the probability
of a transfer of economic benefits is remote.
Contingent liabilities are defined as:
• possible obligations arising from past events whose existence will be confirmed only
by the occurrence of one or more uncertain future events not wholly within the entity’s
control; or
• present obligations arising from past events but for which it is not probable that a
transfer of economic benefits will arise or for which the amount of the obligation
cannot be measured with sufficient reliability.
Note 1.12 Public dividend capital
Public dividend capital (PDC) is a type of public sector equity finance based on the excess of
assets over liabilities at the time of establishment of the predecessor NHS trust. HM Treasury
has determined that PDC is not a financial instrument within the meaning of IAS 32.
A charge, reflecting the cost of capital utilised by the NHS foundation trust, is payable as
public dividend capital dividend. The charge is calculated at the rate set by HM Treasury
(currently 3.5%) on the average relevant net assets of the NHS foundation trust during the
financial year. Relevant net assets are calculated as the value of all assets less the value of
all liabilities, except for (i) donated assets (including lottery funded assets), (ii) average daily
cash balances held with the Government Banking Services (GBS) and National Loans Fund
(NLF) deposits, excluding cash balances held in GBS accounts that relate to a short- term
working capital facility, and (iii) any PDC dividend balance receivable or payable. In
accordance with the requirements laid down by the Department of Health (as the issuer of
PDC), the dividend for the year is calculated on the actual average relevant net assets as set
out in the “pre-audit” version of the annual accounts. The dividend thus calculated is not
revised should any adjustment to net assets occur as a result the audit of the annual
accounts.
Note 1.13 Value added tax
Most of the activities of the NHS foundation trust are outside the scope of VAT and, in
general, output tax does not apply and input tax on purchases is not recoverable.
Irrecoverable VAT is charged to the relevant expenditure category or included in the
capitalised purchase cost of fixed assets. Where output tax is charged or input VAT is
recoverable, the amounts are stated net of VAT.
Note 1.14 Corporation tax
The Trust has determined that it has no corporation tax liability as it does not operate any
commercial activities that are not part of core health care delivery.
123
Note 1.15 Foreign exchange
The functional and presentational currencies of the trust are sterling.
A transaction which is denominated in a foreign currency is translated into the functional
currency at the spot exchange rate on the date of the transaction.
Where the trust has assets or liabilities denominated in a foreign currency at the Statement of
Financial Position date:
• monetary items (other than financial instruments measured at “fair value through
income and expenditure”) are translated at the spot exchange rate on 31 March;
• non-monetary assets and liabilities measured at historical cost are translated using
the spot exchange rate at the date of the transaction; and
• non-monetary assets and liabilities measured at fair value are translated using the
spot exchange rate at the date the fair value was determined.
Exchange gains or losses on monetary items (arising on settlement of the transaction or on
re-translation at the Statement of Financial Position date) are recognised in income or
expense in the period in which they arise.
Exchange gains or losses on non-monetary assets and liabilities are recognised in the same
manner as other gains and losses on these items.
Note 1.16 Third party assets
Assets belonging to third parties (such as money held on behalf of patients) are not
recognised in the accounts since the NHS foundation trust has no beneficial interest in them.
However, they are disclosed in a separate note to the accounts in accordance with the
requirements of HM Treasury’s FReM.
Note 1.17 Losses and special payments
Losses and special payments are items that Parliament would not have contemplated when
it agreed funds for the health service or passed legislation. By their nature they are items that
ideally should not arise. They are therefore subject to special control procedures compared
with the generality of payments. They are divided into different categories, which govern the
way that individual cases are handled. Losses and special payments are charged to the
relevant functional headings in expenditure on an accruals basis, including losses which
would have been made good through insurance cover had NHS foundation trusts not been
bearing their own risks (with insurance premiums then being included as normal revenue
expenditure).
However the losses and special payments note is compiled directly from the losses and
compensations register which reports on an accrual basis with the exception of provisions for
future losses.
Note 1.18 Transfers of functions to / from other NHS bodies / local government bodies
No functions have been trasnferred from another NHS or local government body.
124
Note 1.19 Early adoption of standards, amendments and interpretations
No new accounting standards or revisions to existing standards have been early adopted in
2014-15.
Note 1.20 Standards, amendments and interpretations in issue but not yet effective or adopted
As required by IAS 8, foundation trusts should disclose any standards, amendments and
interpretations that have been issued but are not yet effective or adopted for the public sector
and an assessment subsequent application will have on the financial statements. The
application of the Standards as revised would not have a material impact on the accounts for
2014-15, were they applied in that year:
IFRS 9 Financial Instruments - subject to consultation - subject to consultation
IFRS 13 Fair Value Measurement - subject to consultation
IFRS 15 Revenue from Contracts with Customers
Note 1.21 Critical accounting estimates and judgements
In the application of the Trust’s accounting policies, management is required to make
judgements, estimates and assumptions about the carrying amounts of assets and liabilities
that are not readily apparent from other sources. The estimates and associated assumptions
are based on historical experience and other factors that are considered to be relevant.
Actual results may differ from those estimates and the estimates and underlying assumptions
are continually reviewed. Revisions to accounting estimates are recognised in the period in
which the estimate is revised if the revision affects only that period or in the period of the
revision and future periods if the revision affects both current and future periods.
The following are the critical judgements, apart from those involving estimations (see below)
that management has made in the process of applying the Trust’s accounting policies and
that have the most significant effect on the amounts recognised in the financial statements.
Critical judgements have been made in assessing the classification of estates rental charges,
between operating and finance leases.
Additionally a critical judgement has been made not to consolidate the Bridgewater element
of the registered charity 5 Boroughs Partnership NHS Trust Charitable Fund (charity number
1061651). In making this judgement the Trust has made reference to the Annual Reporting
Manual. The Bridgewater element of this fund is managed under an SLA with 5 Boroughs
Parnership NHS Trust. Whilst Bridgewater is able to requisition expenditure from this fund
within the constraints of the fund objective, corporate trusteeship of the fund remains with 5
Boroughs Partnership NHS Trust. Where a body acts as corporate trustee, there is a
presumption that the body possesses ‘control’ of the fund. Therefore there is no need for
Bridgewater to consolidate.
125
in the accounts as at the 31st March 2014. Subsequently a desk top valuation of the
Trust's estate was
obtained on 31 March 2015 and this has been the basis for the valuation as at 31st March
2015.
A full valuation of the Trusts estate was undertaken on 31st March 2014 by the District Valuer
who is a qualified surveyor registered with the Royal Institute of Chartered Surveyors. The
Note 2 Operating
impact
of this valuation was reflected in the accounts as at the 31st March 2014.
Segments
Subsequently a desk top valuation of the Trust’s estate was obtained on 31 March 2015 and
this has been the basis for the valuation as at 31st March 2015.
Bridgewater Community Healthcare NHS Foundation Trust
Note
2 Operating
Segments
operates
in a single segment,
the provision of healthcare
community services.
Bridgewater
Community Healthcare NHS Foundation Trust operates in a single segment, the
There are therefore
no reportable
provision
of healthcare
community services. There are therefore no reportable segments.
segments.
Income from transactions with the following organisations is in excess of 10% of total income.
Income from transactions with the following organisations is in excess of 10% of total
income.
CCGs and NHS England
Local authorities
2014-15:
For the 5
months
ending 31
March 2015
£000
53,393
6,769
Note 3 Operating income from patient care activities
Note 3 Operating income from patient care activities
Note
3.1Income
Income
patient
care activities
Note 3.1
fromfrom
patient
care activities
(by nature)(by nature)
Community services
Community services income from CCGs and NHS England
Community services income from other commissioners
Total income from activities
2014-15:
For the 5 months
ending 31 March 2015
£000
53,393
8,652
62,045
Note 3.2 Income from patient care activities (by source)
Page 121
126
Note 3.2 Income from patient care activities (by source)
Income from patient care activities received from
Income from patient care activities received from:
CCGs and NHS England
Local authorities
Other NHS foundation trusts
NHS trusts
NHS other
NHS injury scheme (was RTA)
Non NHS: other
Total income from activities
Of which:
Related to continuing operations
Related to discontinued operations
2014-15:
For the 5 months
£000
53,393
6,769
151
168
519
284
761
62,045
62,045
-
Revenue
frompatient
patient
care
services
includes
accrued
activity
where
Revenue from
care
services
includes
income income
accrued for
activity for
where
data is
not data is not
available
at
31st
March
2015.
Wherever
possible
reference
is
made
back
to
available at 31st March 2015. Wherever possible reference is made back to final data butfinal data but
estimates
andassumptions
assumptions
are applied
tothe
ensure
the completeness
estimates and
are applied
in orderintoorder
ensure
completeness
of income of income
reported.
reported.
Injury cost
cost recovery
scheme
is subject
to a provision
for impairment
of receivables
of
Injury
recovery
scheme
is subject
to a provision
for impairment
of receivables
of 18.9%
18.9%
(13/14:15.8%)
to
reflect
expected
rates
of
collection.
(13/14:15.8%) to reflect expected rates of collection.
Note 4 Other operating income
Note 4 Other operating income
Research and development
Education and training
Receipt of capital grants and donations
Charitable and other contributions to expenditure
Non-patient care services to other bodies
Profit on disposal of non-current assets
Reversal of impairments
Rental revenue from operating leases
Rental revenue from finance leases
Amortisation of PFI deferred credits
Income in respect of staff costs where accounted on gross basis
Other income
Total other operating income
Of which:
2014-15:
For the 5 months
£000
1,021
1,021
1,021
Page 122
127
Note 4.1 Income from activities arising from commissioner requested services
Note 4.1 Income from activities arising from commissioner requested services
Under the terms of its Provider License, the trust is required to analyse the level of income
Under
the terms
of its
Provider
License, therequested
trust is required
to analyse the level of income
from activities
that has
arisen
from commissioner
and non-commissioner
from
activities
thatCommissioner
has arisen requested
from commissioner
requested
non-commissioner
requested
services.
services are defined
in theand
provider
license and
are services that
commissioners
believe would
need toservices
be protected
the event
of provider
requested
services.
Commissioner
requested
are in
defined
in the
provider license and
failure.
This
information
is
provided
in
the
table
below:
are services that commissioners believe would need to be protected in the event of provider
failure. This information is provided in the table below:
Income from services designated (or grandfathered) as
commissioner requested services
Income from services not designated as commissioner
requested services
Total
2014-15
£000
62,045
62,045
Note 5 Operating expenses
Services from NHS foundation trusts
Services from NHS trusts
Services from CCGs and NHS England
Services from other NHS bodies
Purchase of healthcare from non NHS bodies
Purchase of social care
Employee expenses - executive directors
Employee expenses - non-executive directors
Employee expenses - staff
Supplies and services - clinical
Supplies and services - general
Establishment
Transport
Premises
Increase/(decrease) in provision for impairment of receivables
Increase/(decrease) in other provisions
Change in provisions discount rate(s)
Inventories written down
Drug costs
Inventories consumed
Rentals under operating leases
Depreciation on property, plant and equipment
2014-15:
For the 5 months
ending 31 March
2015
£000
1,741
1,138
139
322
277
42
43,234
3,436
1,332
998
971
1,887
27
11
687
4,955
623
Page 123
128
commissioner requested services
Income from services not designated as commissioner
requested services
Total
62,045
62,045
Services from NHS foundation trusts
Services from NHS trusts
Services from CCGs and NHS England
Services from other NHS bodies
Purchase of healthcare from non NHS bodies
Purchase of social care
Employee expenses - executive directors
Employee expenses - non-executive directors
Employee expenses - staff
Supplies and services - clinical
Supplies and services - general
Establishment
Transport
Premises
Increase/(decrease) in provision for impairment of receivables
Increase/(decrease) in other provisions
Change in provisions discount rate(s)
Inventories written down
Drug costs
Inventories consumed
Rentals
underon
operating
leases
Amortisation
intangible
assets
Depreciation
on
property,
plant
and equipment
Impairments
Audit fees payable to the external auditor
audit services- statutory audit
audit services- regulatory reporting (external auditor
only)
other auditor remuneration (external auditor only)
Clinical negligence
Loss on disposal of non-current assets
Legal fees
Consultancy costs
Training, courses and conferences
Patient travel
Car parking & security
Redundancy
Early retirements
Hospitality
Publishing
Insurance
Other services, eg external payroll
Grossing up consortium arrangements
Losses, ex gratia & special payments
Other
Total
Of which:
2014-15:
For the 5 months
ending 31 March
2015
£000
1,741
1,138
139
322
277
42
43,234
3,436
1,332
998
971
1,887
27
11
687
4,955
20
62353
Page 123
108
125
308
125
5
6
163
62,733
62,733
-
Annual
Report
Operating expenses includes expenditure accrued for which no Bridgewater
invoice has been
received
by2014/15
31st March 129
2015. In some cases it is necessary to use estimates based on knowledge of goods and services received.
Wherever possible reference is made back to the value of orders but estimates and assumptions are
Of which:
62,733
-
Operating
expenses
includesincludes
expenditure
accrued for
whichfor
no which
invoiceno
hasinvoice
been received
byreceived
31st March
Operating
expenses
expenditure
accrued
has been
2015.by
In 31st
someMarch
cases it2015.
is necessary
use estimates
based on
of goods
and
received.
In sometocases
it is necessary
to knowledge
use estimates
based
onservices
knowledge
Wherever
possible
reference
is
made
back
to
the
value
of
orders
but
estimates
and
assumptions
areof
of goods and services received. Wherever possible reference is made back to the value
applied
in order
ensure the
completeness
of are
expenditure
reported.
to the
of transactions
orders
butto
estimates
and
assumptions
applied in
order to Due
ensure
thevolume
completeness
of
adjustments
are not
made toDue
priortoperiods
unlessofthe
difference between
the estimate
and thetoactual
expenditure
reported.
the volume
transactions
adjustments
are not made
prior
value periods
is material
unless the difference between the estimate and the actual value is material
For expenditure accruals, any variation in outcome compared to the estimates used are
For expenditure
variation
outcome
compared
the estimatesare
used
are accounted
for in
accountedaccruals,
for in theany
next
period.inThese
estimates
andtoassumptions
consistent
with the
the next
period.year
These estimates and assumptions are consistent with the previous year
previous
Directors remuneration is set out above and includes employer contributions to the NHS
Directors
remuneration
Pension
Scheme is set out above and includes employer contributions to the NHS Pension Scheme
Note 5.1 Other auditor remuneration
Note 5.1 Other auditor remuneration
2014-15:
For the 5 months
ending 31 March
2015
£000
Page 124
Other auditor remuneration paid to the external auditor:
1. Audit of accounts of any associate of the trust
2. Audit-related assurance services
3. Taxation compliance services
4. All taxation advisory services not falling within item 3 above
5. Internal audit services
6. All assurance services not falling within items 1 to 5
7. Corporate finance transaction services not falling within items
1 to 6 above
8. Other non-audit services not falling within items 2 to 7 above
Total
-
Note 5.2
on auditor's
liabilityliability
Note
5.2Limitation
Limitation
on auditor’s
The limitation on auditors liability for external audit work carried out for the financial
The
limitation on auditors liability for external audit work carried out for the financial years
years 2014-15 is £2 million.
2014-15 is £2 million.
Note 66Impairment
of assets
Note
Impairment
of assets
There
hasbeen
been
impairment
of assets
in the reporting
There has
nono
impairment
of assets
in the reporting
period period
Note 7 Employee benefits
Salaries and wages
Social security costs
Bridgewater
Annual
Report
2014/15
130
Employer's contributions
to NHS
pensions
Pension cost - other
Other post-employment benefits
Permanent
£000
34,608
2,559
4,379
4
-
Other
£000
84
140
-
2014-15:
For the 5 months
ending 31 March
2015
Total
£000
34,692
2,699
4,379
4
-
Note 6 Impairment of assets
There has been no impairment of assets in the reporting period
Note 77Employee
benefits
Note
Employee
benefits
Salaries and wages
Social security costs
Employer's contributions to NHS pensions
Pension cost - other
Other post-employment benefits
Other employment benefits
Termination benefits
Agency/contract staff
Total gross staff costs
Recoveries in respect of seconded staff
Total staff costs
Included within:
Costs capitalised as part of assets
Permanent
£000
34,608
2,559
4,379
4
41,550
41,550
Other
£000
84
140
2,338
2,562
2,562
2014-15:
For the 5 months
ending 31 March
2015
Total
£000
34,692
2,699
4,379
4
2,338
44,112
44,112
46
555
601
Permanent
Number
62
669
Other
Number
46
45
2014-15:
For the 5 months
ending 31 March
2015
Total
Number
108
714
276
1,168
41
276
1,209
12
438
2,625
41
4
177
12
479
4
2,802
15
8
23
Note 7.1 Average number of employees (WTE basis)
Note 7.1 Average number of employees
(WTE basis)
Medical and dental
Ambulance staff
Administration and estates
Healthcare assistants and other support
staff
Nursing, midwifery and health visiting staff
Nursing, midwifery and health visiting
learners
Scientific, therapeutic and technical staff
Social care staff
Agency and contract staff
Bank staff
Other
Total average numbers
Of which:
Number of employees (WTE) engaged on
capital projects
Page 125
Note 7.2 Retirements due to ill-health
Note 7.2 Retirements due to ill-health
During
theperiod
period
from
November
2014
31st2015
March
2015
1 earlyfrom
retirement
During the
from
1st1st
November
2014 to
31stto
March
there
was there
1 earlywas
retirement
the
trust agreed
on agreed
the grounds
of ill-health.
pensionadditional
liability of this
ill-health
from
the trust
on the
groundsThe
of estimated
ill-health.additional
The estimated
pension
liability of
retirement
is £27k.
this
ill-health
retirement is £27k.
The cost of these ill-health retirements will be borne by the NHS Business Services Authority Bridgewater Annual Report 2014/15
Pensions Division.
Note 7.3 Reporting of compensation schemes - exit packages
131
The cost of these ill-health retirements will be borne by the NHS Business Services Authority
- Pensions Division.
Note 7.3 Reporting of compensation schemes - exit packages 2014-15
There were no exit packages agreed in the period from 1st November 2014 to 31st March
2015.
Note 7.4 Exit packages: other (non-compulsory) departure payments
There were no other exit packages agreed in the reporting period.
Note 7.5 Directors’ remuneration
The aggregate amounts payable to directors were:
Salary
Taxable benefits
Performance related bonuses
Employer's pension contributions
Total
2014-15:
For the 5 months ending 31
March 2015
£000
349
9
0
37
395
Further details of directors' remuneration can be found in the remuneration report.
Further
details of directors’ remuneration can be found in the remuneration report.
Note
Pension
Note 88Pension
costscosts
Past and present employees are covered by the provisions of the NHS Pensions Scheme.
Past and present employees are covered by the provisions of the NHS Pensions Scheme. Details of
Details
of the benefits payable under these provisions can be found on the NHS Pensions
the benefits payable under these provisions can be found on the NHS Pensions website at
website
at www.nhsbsa.nhs.uk/pensions.
The scheme
is an
unfunded,
benefit
www.nhsbsa.nhs.uk/pensions.
The scheme is an unfunded,
defined
benefit
schemedefined
that covers
NHS
scheme
that
covers
NHS
employers,
GP
practices
and
other
bodies,
allowed
under
employers, GP practices and other bodies, allowed under the direction of the Secretary of State, inthe
direction
ofWales.
the Secretary
of is
State,
in England
Thewould
scheme
is not
England and
The scheme
not designed
to be and
run inWales.
a way that
enable
NHSdesigned
bodies to to be
run
in atheir
wayshare
that of
would
enable NHS
bodies
identify
their
share ofthe
the
underlying
scheme
identify
the underlying
scheme
assetsto
and
liabilities.
Therefore,
scheme
is
accounted
forliabilities.
as if it were
a defined contribution
scheme:
the cost tofor
the
assets
and
Therefore,
the scheme
is accounted
asNHS
if itBody
wereofaparticipating
defined
in the scheme scheme:
is taken as the
equal
to the
payable
to the schemeinfor
thescheme
accounting
contribution
cost
to contributions
the NHS Body
of participating
the
is taken as
period.
equal to the contributions payable to the scheme for the accounting period.
The scheme is subject to a full actuarial valuation every 4 years (until 2004, every 5 years) and an
The
scheme is subject to a full actuarial valuation every 4 years (until 2004, every 5 years)
accounting valuation every year. An outline of these follows:
and an accounting valuation every year. An outline of these follows:
a) Full actuarial (funding) valuation
TheFull
purpose
of this (funding)
valuation is to
assess the level of liability in respect of the benefits due under the
a)
actuarial
valuation
scheme
(taking of
into
account
its recent
and toinrecommend
The
purpose
this
valuation
is todemographic
assess theexperience),
level of liability
respect ofthe
the benefits due
contribution
rates
to
be
paid
by
employers
and
scheme
members.
The
last
such
valuation,
which
under the scheme (taking into account its recent demographic experience), and
to
determined current
contribution rates
at 31 Marchand
2004scheme
and covered
the period
recommend
the contribution
rateswas
to undertaken
be paid byasemployers
members.
The last
from
1
April
1999
to
that
date.
The
conclusion
from
the
2004
valuation
was
that
the
scheme
had
such valuation, which determined current contribution rates was undertaken as at 31 March
accumulated a notional deficit of £3.3 billion against the notional assets as at 31 March 2004.
2004 and covered the period from 1 April 1999 to that date. The conclusion from the 2004
valuation
hademployers
accumulated
a notionalatdeficit
£3.3 billion
against
the
In order to was
defraythat
thethe
costsscheme
of benefits,
pay contributions
14% ofofpensionable
pay
and
notional
assetshad
as up
at to
31April
March
most employees
20082004.
paid 6%, with manual staff paying 5%.
Following the full actuarial
review
by2014/15
the Government Actuary undertaken as at 31 March 2004, and
Bridgewater
Annual
Report
132
after consideration of changes to the NHS Pension Scheme taking effect from 1 April 2008, his
Valuation report recommended that employer contributions could continue at the existing rate of
14% of pensionable pay, from 1 April 2008, following the introduction of employee contributions on
In order to defray the costs of benefits, employers pay contributions at 14% of pensionable
pay and most employees had up to April 2008 paid 6%, with manual staff paying 5%.
Following the full actuarial review by the Government Actuary undertaken as at 31 March
2004, and after consideration of changes to the NHS Pension Scheme taking effect from 1
April 2008, his Valuation report recommended that employer contributions could continue at
the existing rate of 14% of pensionable pay, from 1 April 2008, following the introduction of
employee contributions on a tiered scale from 5% up to 8.5% of their pensionable pay
depending on total earnings.
On advice from the scheme actuary, scheme contributions may be varied from time to time
to reflect changes in the scheme’s liabilities.

b) Accounting valuation
A valuation of the scheme liability is carried out annually by the scheme actuary as at the end
of the reporting period by updating the results of the full actuarial valuation.
Between the full actuarial valuations at a two-year midpoint, a full and detailed member
data-set is provided to the scheme actuary. At this point the assumptions regarding the
composition of the scheme membership are updated to allow the scheme liability to be
valued.
The valuation of the scheme liability as at 31 March 2011, is based on detailed membership
data as at 31 March 2008 (the latest midpoint) updated to 31 March 2011 with summary
global member and accounting data.
The latest assessment of the liabilities of the scheme is contained in the scheme actuary
report, which forms part of the annual NHS Pension Scheme (England and Wales) Resource
Account, published annually. These accounts can be viewed on the NHS Pensions website.
Copies can also be obtained from The Stationery Office.
c) Scheme provisions
The NHS Pension Scheme provided defined benefits, which are summarised below. This
list is an illustrative guide only, and is not intended to detail all the benefits provided by the
Scheme or the specific conditions that must be met before these benefits can be obtained:
The Scheme is a “final salary” scheme. Annual pensions are normally based on 1/80th for
the 1995 section and of the best of the last three years pensionable pay for each year of
service, and 1/60th for the 2008 section of reckonable pay per year of membership.
Members who are practitioners as defined by the Scheme Regulations have their annual
pensions based upon total pensionable earnings over the relevant pensionable service.
With effect from 1 April 2008 members can choose to give up some of their annual pension
for an additional tax free lump sum, up to a maximum amount permitted under HMRC rules.
This new provision is known as “pension commutation”.
Annual increases are applied to pension payments at rates defined by the Pensions
(Increase) Act 1971, and are based on changes in retail prices in the twelve months ending
30 September in the previous calendar year.
133
Early payment of a pension, with enhancement, is available to members of the scheme who
are permanently incapable of fulfilling their duties effectively through illness or infirmity. A
death gratuity of twice final year’s pensionable pay for death in service, and five times their
annual pension for death after retirement is payable.
For early retirements other than those due to ill health the additional pension liabilities are not
funded by the scheme. The full amount of the liability for the additional costs is charged to
the employer.
Members can purchase additional service in the NHS Scheme and contribute to money
purchase AVC’s run by the Scheme’s approved providers or by other Free Standing
Additional Voluntary Contributions (FSAVC) providers.
Note
99Operating
leases
Note
9Operating
Operating
leases
Note
leases
Operating
lease
expense
Operating
lease
expense
Minimum
lease
payments
Minimum
lease
payments
Contingent
rents
Contingent
rents
Less
sublease
payments
received
Less
sublease
payments
received
Total
Total
Future
minimum
lease
payments
due:
Future
minimum
lease
payments
due:
- not
later
than
one
year;
- not
later
than
one
year;
- later
than
one
year
and
not
later
than
five
years;
- later
than
one
year
and
not
later
than
five
years;
- later
than
five
years.
- later
than
five
years.
Total
Total
Future
minimum
sublease
payments
toto
bebe
received
Future
minimum
sublease
payments
received
2014-15:
2014-15:
ForFor
the
5 months
the
5 months
ending
3131
March
2015
ending
March
2015
£000
£000
4,955
4,955
- - 4,955
4,955
3131
March
2015
March
2015
£000
£000
10,183
10,183
2,052
2,052
1,556
1,556
13,791
13,791
- -
Bridgewater Community Healthcare has included within lease costs occupancy charges in
relation to
occupancy
of premises
owned
andlease
controlled
by
NHS charges
Property
Services
Bridgewater
Community
Healthcare
has
included
within
costs
occupancy
in in
relation
Bridgewater
Community
Healthcare
has
included
within
lease
costs
occupancy
charges
relation Ltd and
Community
Health
Partnerships.
Whilst
we
occupy
properties
from
CHP
and
NHS
Property
toto
occupancy
of of
premises
owned
and
controlled
byby
NHS
Property
Services
LtdLtd
and
Community
Health
occupancy
premises
owned
and
controlled
NHS
Property
Services
and
Community
Health
Services under
arrangements
which
which
we
consider
to be
operating
leases,
we do
not
Partnerships.
Whilst
we
occupy
properties
from
CHP
and
NHS
Property
Services
under
arrangements
which
Partnerships.
Whilst
we
occupy
properties
from
CHP
and
NHS
Property
Services
under
arrangements
which
have
agreed
formal
lease
arrangements
in
place.
which
wewe
consider
toto
bebe
operating
leases,
wewe
dodo
not
have
agreed
formal
lease
arrangements
in in
place.
which
consider
operating
leases,
not
have
agreed
formal
lease
arrangements
place.
The
minimum
future
year
lease
payments
disclosed
above
therefore
only
include
our
expected
costs
forfor
these
The
minimum
future
year
lease
payments
disclosed
above
therefore
only
include
our
expected
costs
these
properties
for
2015/16.
properties
for
2015/16.
The minimum future year lease payments disclosed above therefore only include our
expected costs for these properties for 2015/16.
Note
1010
Finance
income
Note
Finance
income
Note 10 Finance income
Interest
onon
bank
accounts
Interest
bank
accounts
Total
Total
Note
1111
Corporation
taxtax
Note
Corporation
134
There
was
nono
corporation
taxtax
due
in in
this
reporting
period
There
was
corporation
due
this
reporting
period
2014-15:
2014-15:
ForFor
the
5 months
the
5 months
ending
3131
March
2015
ending
March
2015
£000
£000
88
88
Note 11 Corporation tax
There was no corporation tax due in this reporting period
Note 12 Discontinued operations
There
period were no discontinued operations in this reporting period
Note 13 Intangible assets - 2014-15
Note 13 Intangible assets - 2014-15
Valuation/gross cost at at 1 November 2014
- brought forward
Transfers by absorption
Additions
Impairments
Reversals of impairments
Reclassifications
Revaluations
Transfers to/ from assets held for sale
Disposals / derecognition
Gross cost at 31 March 2015
Amortisation at 1 November 2014 - brought
forward
Provided during the year
Impairments
Reclassifications
Revaluations
Transfers to/ from assets held for sale
Amortisation at 31 March 2015
Net book value at 31 March 2015
Net book value at 1 November 2014
Internally generated
information technology
£000
177
177
49
20
69
108
128
Page 130
135
136
Net book value 1 November 2014
Purchased
Finance leased
Donated and government grant funded
NBV total at 1 November 2014
-
-
-
Software Licences &
licences trademarks
£000
£000
-
Software Licences &
licences trademarks
£000
£000
Note 13.2 Intangible assets financing 1 November 2014
Purchased
Finance leased
Donated and government grant funded
NBV total at 31 March 2015
Note 13.1 Intangible assets financing 201415
108
108
-
-
128
128
-
Internally
generated
information Development
Patents technology expenditure
£000
£000
£000
-
Internally
generated
information Development
Patents technology expenditure
£000
£000
£000
-
Other
£000
-
Other
£000
-
-
-
Intangible
assets
under
Goodwill construction
£000
£000
-
Intangible
assets
under
Goodwill construction
£000
£000
128
128
Total
£000
108
108
Total
£000
Note 13.1 Intangible assets financing 2014-15
Note 14 Property, plant and equipment - 2014-15
Note 14 Property, plant and equipment 2014-15
Valuation/gross cost at 1 November
2014 - brought forward
Opening Adjustments
Additions
Impairments
Reclassifications
Revaluations
Transfers to/ from assets held for
sale
Valuation/gross cost at 31 March
2015
Accumulated depreciation at 1
November 2014
Provided during the year
Impairments
Reclassifications
Revaluations
Transfers to/ from assets held for
sale
Disposals/ derecognition
Accumulated depreciation at 31
March 2015
Net book value at 1 November 2014
Buildings
excluding
Plant & Information Furniture
Land dwellings machinery technology & fittings
£000
£000
£000
£000
£000
2,424
9,184
-
Total
£000
6,468
658
222
360
1,845
2,946
693
-
1,591
-
-
20,579
2,946
2,506
360
-
-
-
-
-
-
2,424
9,766
5,484
8,059
658
26,391
-
435
126
-
824
78
-
1,807
386
-
127
33
-
3,193
623
-
-
-
-
-
-
-
-
561
902
2,193
160
3,816
2,424
2,424
9,205
8,749
4,582
1,021
5,866
4,661
498
531
22,575
17,386
The opening adjustment of £2,946k ensures consistent application of IAS1 accounting policy revised with effect
from 1st November 2014.
Note 14.1 Property, plant and equipment financing 2014-15
Buildings
excluding
£000
£000
£000
£000
£000
Owned
2,388
8,988
4,565
5,866
498
Finance leased
-
Total
£000
22,305
-
137
The opening adjustment of £2,946k ensures consistent application of IAS1 accounting policy revised with effect
from 1st November 2014.
Note
14.1
Property,
and equipment
Note 14.1
Property,
plantplant
and equipment
financing -financing - 2014-15
2014-15
Owned
Finance leased
On-SoFP PFI contracts and other
service concession arrangements
PFI residual interests
Government granted
Donated
NBV total at 31 March 2015
Buildings
excluding
£000
£000
£000
£000
£000
Total
£000
2,388
-
8,988
-
4,565
-
5,866
-
498
-
22,305
-
36
2,424
217
9,205
17
4,582
5,866
498
253
17
22,575
Note 15 Revaluations
of plant
property,
plant
and equipment
Note 15 Revaluations
of property,
and
equipment
All
theTrusts
Trustsowned
owned
Land
& Buildings
have
been revalued
at 31st
All of
of the
Land
& Buildings
have been
revalued
at 31st March
2015.March
The 2015. The
revaluation
was
carried
independently
revaluation was
carried
outout
independently
by: by:
DVS --Property
Services
arm arm
of theofVOA
MRICS RICS
DVS
Property
Services
the(DipSurv
VOA (DipSurv
MRICS RICS Registered Valuer)
Registered
Valuer)
Crewe Valuation Office
Crewe
Valuation
Office House
2nd
Floor
Wellington
2nd Floor Wellington House
Delamere Street Crewe
Delamere Street
CW1
2LQ
Crewe
CW1 2LQ
The revaluation was undertaken in accordance with International Financial Reporting
Standards
(IFRS)
interpreted
and applied
by the Annual
Reporting
Manual. The
The revaluation
was as
undertaken
in accordance
with International
Financial
Reporting
assumption
has
madeand
that
the properties
valued
will continue
to be held for the
Standards (IFRS)
as been
interpreted
applied
by the Annual
Reporting
Manual. The
assumption
has
been
made
that
the
properties
valued
will
continue
to
be
held
for
the
foreseeable future having regard to the prospect and viability of the continuance
of
foreseeable future
to the prospect
and viability
thebeen
continuance
of
occupation.
The having
basis regard
of valuation
is Fair Value
whichofhas
interpreted
as market value
occupation.
basis of valuation is Fair Value which has been interpreted as market value
for
existingThe
use.
for existing use.
For those properties where there is market-based evidence to support the use of ‘Existing
For those properties where there is market-based evidence to support the use of ‘Existing
Use
Value’ (EUV) to arrive at Fair Value the comparative method of valuation has been
Use Value’ (EUV) to arrive at Fair Value the comparative method of valuation has been
adopted.
adopted.
For
thoseproperties
properties
where
there
no market
based evidence
the use of EUV to
For those
where
there
is nois
market
based evidence
to supportto
thesupport
use of EUV
arrive
at at
Fair
Depreciated
Replacement
Cost approach
(DRC) approach
has been used.
to arrive
FairValue,
Value, the Depreciated
Replacement
Cost (DRC)
has been used.
Note 16 Investments - 2014-15
Note 16 Investments - 2014-15
The Trust does not hold any investments
The Trust does not hold any investments
The Trust does not have any interests in other entities
The Trust does not have any interests in other
entities
Note 18 Inventories
138
31 March 2015
£000
The Trust does not have any interests in other
entities
Note 18 Inventories
Note 18 Inventories
31 March 2015
£000
39
39
Drugs
Other
Total inventories
Page 133
Inventories recognised in expenses for the year were £0k. Write-down of inventories
recognised as expenses for the year were £0k.
Note
19Trade
Trade
receivables
andreceivables
other receivables
Note 19
receivables
and other
31 March 2015
£000
Current
Trade receivables due from NHS bodies
Provision for impaired receivables
Prepayments (non-PFI)
Accrued income
VAT receivable
Other receivables
Total current trade and other receivables
5,502
(275)
1,299
724
122
2,666
10,038
Non-current
Provision for impaired receivables
Other receivables
Total non-current trade and other receivables
(122)
762
640
Note
19.1Provision
Provision
for impairment
of receivables
Note 19.1
for impairment
of
receivables
2014-15
£000
370
27
397
At 1 November 2014
Increase in provision
Amounts utilised
Unused amounts reversed
At 31 March 2015
Note 19.2 Analysis of impaired
receivables
Ageing of impaired receivables
0 - 30 days
Trade
receivables
£000
-
31 March 2015
Other receivables
£000
Page 134
139
Unused amounts reversed
At 31 March 2015
397
Note 19.2
Analysis
of impaired
Note
19.2
Analysis
of impaired receivables
receivables
Ageing of impaired receivables
0 - 30 days
30-60 Days
60-90 days
90- 180 days
Over 180 days
Total
Trade
receivables
£000
397
397
31 March 2015
Other receivables
£000
-
Ageing of non-impaired receivables past their
due date
0 - 30 days
1,523
30-60 Days
640
60-90 days
603
90- 180 days
1,005
Over 180 days
1,594
Total
5,365
Page 134
-
Note
20Other
Other
assets
Note 20
assets
The
Trustdoes
does
have
other
assets
The Trust
notnot
have
other
assets
Note 21
financial
assetsassets
Note
21Other
Other
financial
The
Trustdoes
does
have
other
financial
The Trust
notnot
have
other
financial
assetsassets
Note 22 Non-current assets for sale and assets in disposal
Note
groups22 Non-current assets for sale and assets in disposal groups
The
Trustdoes
does
have
non-current
The Trust
notnot
have
any any
non-current
assets assets
for sale for sale
Note 23 Cash and cash equivalents movements
Cash and cash equivalents comprise cash at bank, in hand and cash
equivalents. Cash equivalents are readily convertible investments of known
value which are subject to an insignificant risk of change in value.
At 1 November 2014
Net change in year
At 31 March
Broken down into:
Cash at commercial banks and in hand
Cash with the Government Banking Service
Deposits with the National Loan Fund
Bridgewater
Annual Report 2014/15
140
Other current investments
2014-15
£000
5,349
512
5,861
29
5,832
Page 135
The Trust does not have any non-current assets for sale
Note2323
Cash
and equivalents
cash equivalents
movements
Note
Cash
and cash
movements
Cash and cash equivalents comprise cash at bank, in hand and cash
equivalents. Cash equivalents are readily convertible investments of known
value which are subject to an insignificant risk of change in value.
At 1 November 2014
Net change in year
At 31 March
Broken down into:
Cash at commercial banks and in hand
Cash with the Government Banking Service
Deposits with the National Loan Fund
Othercash
current
Total
andinvestments
cash equivalents as in SoFP
Total
cash
and
as in SoFP
Bank overdraftscash
(GBSequivalents
and commercial
banks)
Bank
overdrafts
(GBS
and
commercial
banks)
Drawdown in committed facility
Drawdown
in
committed
facility
Total cash and cash equivalents as in SoCF
Total cash and cash equivalents as in SoCF
2014-15
£000
5,349
512
5,861
29
5,832
5,8615,861-5,8615,861
Page 135
Note 23.1 Third party assets held by the NHS foundation
Note
23.1Third
Third
party
byfoundation
the NHS foundation trust
Note 23.1
party
assetsassets
held byheld
the NHS
trust
trust
The Trust does not hold any third party assets
Note 24
andand
otherother
payables
Note
24Trade
Trade
payables
Note 24 Trade and other payables
Current
Current
NHS
trade payables
NHS
Othertrade
tradepayables
payables
Other
payables
Capitaltrade
payables
Capitalsecurity
payables
Social
costs
Social
security
Other payablescosts
Other payables
Accruals
Accruals
Total
current trade and other
Total
current trade and other
payables
payables
Non-current
Non-current
Receipts
in advance
Receipts
advance
NHS
tradeinpayables
NHS
trade
payables
Amounts due to other related parties
Amounts
due
to other related parties
Other
trade
payables
Other
trade
payables
Capital payables
Capital
payables
VAT
payable
VAT payable
Other
taxes payable
Other
taxes payable
Other payables
Other
payables
Accruals
Accruals
Total
non-current trade and other
Total non-current
payables trade and other
payables
31 March
31 March
2015
2015
£000
£000
4,589
4,589
5,163
5,163
851
851
1,713
1,713
17
17
4,098
4,098
16,431
16,431
---------
Note 24.1 Early retirements in NHS payables
Note 24.1above
Early retirements in NHS payables
above
There are no early retirements payables in NHS payables above
141
Note 24.1 Early retirements in NHS payables above
There are no early retirements payables in NHS payables above
Note 25 Other financial liabilities
Othernot
liabilities
The Note
Trust26does
have other financial liabilities
The Trust has no other liabilities
Note 26 Other liabilities
Borrowings
The Note
Trust27has
no other liabilities
The Trust has no borrowings
Note 27 Borrowings
The The
Trust
hashas
noaccess
borrowings
Trust
to a £13m revolving credit facility with Lloyds Banking Group.
The Trust has access to a £13m revolving credit facility with Lloyds Banking Group.
Note 28 Finance leases
The
was notleases
a finance lessor or lessee in the reporting period
Note
28Trust
Finance
The Trust was not a finance lessor or lessee in the reporting period
Note 29 Provisions for liabilities and charges analysis
Note 29 Provisions for liabilities and charges analysis
At 1 November 2014
Change in the discount rate
Arising during the year
Utilised during the year
Reclassified to liabilities
held in disposal groups
Reversed unused
Unwinding of discount
At 31 March 2015
Expected timing of cash
flows:
- not later than one year;
- later than one year and
not later than five years;
- later than five years.
Total
Other
legal
claims
£000
47
11
(24)
Total
£000
47
11
(24)
34
34
34
34
34
34
Legal claims provisions relate to LTPS provisions as notified by the NHS Litigation Authority. The provision
Legal
provisions
relate
LTPS
provisions
as notified
by the
NHSAuthority.
Litigation Authority.
reflectsclaims
the probability
of the
casesto
being
settled
as estimated
by the NHS
Litigation
The provision reflects the probability of the cases being settled as estimated by the NHS
Litigation Authority.
Note 30 Clinical negligence liabilities
Page 137
142
Note 30 Clinical negligence liabilities
At 31 March 2015, £0k was included in provisions of the NHSLA in respect of clinical
negligence liabilities of Bridgewater Community Healthcare NHS Foundation Trust
(1 November 2014: £0k).
At 31 March 2015, £0k was included in provisions of the NHSLA in respect of clinical negligence
Note
31ofContingent
assets and
liabilities
liabilities
Bridgewater Community
Healthcare
NHS Foundation Trust (1 November 2014: £0k).
The Trust has no contingent assets and liabilities
Note 31 Contingent assets and liabilities
Note 32 Contractual capital commitments
The Trust
contingent
assetscapital
and liabilities
The
Trusthas
hasnono
contractual
commitments
Note 32 Contractual capital commitments
Interest rate risk
The Trust has no contractual capital commitments
The
Trust borrows from government for capital expenditure, subject to affordability as
confirmed by the department of health. The borrowings are for 1 – 25 years, in line with the
Interest rate risk
life of the associated assets, and interest is charged at the National Loans Fund rate, fixed for
The Trust borrows from government for capital expenditure, subject to affordability as
the
life of the loan. The Trust therefore has low exposure to interest rate fluctuations.
confirmed by the department of health. The borrowings are for 1 – 25 years, in line with the life
of the associated assets, and interest is charged at the National Loans Fund rate, fixed for the
life of the
loan. The Trust therefore has low exposure to interest rate fluctuations.
Credit
risk
Because the majority of the Trust’s revenue comes from contracts with other public sector
Credit risk
bodies, the Trust has low exposure to credit risk. The maximum exposures as at 31st March
2015
arethe
in majority
receivables
customers,
as disclosed
in the
other
receivables
Because
of thefrom
Trust’s
revenue comes
from contracts
withtrade
otherand
public
sector
note.”
bodies, the Trust has low exposure to credit risk. The maximum exposures as at 31st March
2015 are in receivables from customers, as disclosed in the trade and other receivables note."
Liquidity risk
Liquidity risk
The
Trust’soperating
operating
costs
are incurred
under contracts
NHS
bodies,
which are
The Trust’s
costs
are incurred
under contracts
with otherwith
NHSother
bodies,
which
are
financed
fromresources
resources
voted
annually
by Parliament
. The
Trust
fundsexpenditure
its capital expenditure
financed from
voted
annually
by Parliament
. The Trust
funds
its capital
from
internally
generated
resources.
The
Trust
is
not,
therefore,
exposed
to
significant
from internally generated resources. The Trust is not, therefore, exposed to liquidity
significant liquidity
risks.
risks.
Note 33.2
assets
Note
33.2Financial
Financial
assets
Assets as per SoFP as at 31 March
2015
Embedded derivatives
Trade and other receivables excluding
non financial assets
Other investments
Other financial assets
Cash and cash equivalents at bank and
in hand
Total at 31 March 2015
Assets at
fair value
Loans and
through
receivables
the I&E
£000
£000
Held to
maturity
£000
Availablefor-sale
£000
Total
£000
-
-
-
-
-
8,617
-
-
-
-
8,617
-
5,861
14,478
-
-
-
5,861
14,478
Page 138
143
Note 33.3
Financial
liabilities
Note
33.3
Financial
liabilities
Liabilities as per SoFP as at 31 March 2015
Embedded derivatives
Borrowings excluding finance lease and PFI liabilities
Obligations under finance leases
Obligations under PFI, LIFT and other service concession
contracts
Trade and other payables excluding non financial liabilities
Other financial liabilities
Provisions under contract
Total at 31 March 2015
Note 33.4 Maturity of financial
Note
33.4 Maturity of financial liabilities
liabilities
In one year or less
In more than one year but not more than two years
In more than two years but not more than five years
In more than five years
Total
Other
financial
liabilities
£000
Liabilities
at fair
value
through
the I&E
£000
Total
£000
-
-
-
13,312
13,312
-
13,312
13,312
31
March
2015
£000
13,312
13,312
1
November
2014
£000
-
The fair value of financial instruments is considered to be equivalent to the transaction value.
The fair value of financial instruments is considered to be equivalent to the transaction
value.
Note 34 Losses and special payments
2014-15:
March 2015
Total
number of
Total value
cases
of cases
Number
£000
Page 139
144
The fair value of financial instruments is considered to be equivalent to the transaction
value.
2014-15:
March 2015
Total
number of
Total value
cases
of cases
Number
£000
Losses
Cash losses
Fruitless payments
Bad debts and claims abandoned
Stores losses and damage to property
Total losses
Special payments
Extra-contractual payments
Extra-statutory and extra-regulatory payments
Compensation payments
Special severance payments
Ex-gratia payments
Total special payments
Total losses and special payments
Compensation payments received
1
1
5
5
1
5
-
Page 139
There have been no cases individually over £300,000.
Note 35
afterafter
the reporting
date
Note
35Events
Events
the reporting
date
There
arenonoevents
events
after
reporting
There are
after
the the
reporting
periodperiod
Note 36 Related parties
During the reporting period none of the Department of Health Ministers, Trust board members or members
of the key management staff, or parties related to any of them, has undertaken any material transactions
with Bridgewater Community Healthcare NHS Foundation Trust.
The Department of Health is regarded as a related party. During the reporting period Bridgewater has had
a significant number of material transactions (greater than £1 million) with the Department, and with other
entities for which the Department is regarded as the parent Department. For example :
Receivables
Payables
31 March
2015
£000
1
November
2014
£000
31 March
2015
£000
1
November
2014
£000
NHS Halton CCG
406
1,494
49
46
NHS St Helens CCG
427
747
39
36
CCGs
NHS Warrington CCG
NHS Wigan Borough CCG
1,148
1,161
-
145
-
There have been no cases individually over £300,000.
Note 35 Events after the reporting date
There are no events after the reporting period
Note 36 Related parties
Note 36the
Related
partiesperiod none of the Department of Health Ministers, Trust board
During
reporting
During
the
reporting
period
of the
Department ofstaff,
HealthorMinisters,
Trust board
members
or members
members or members
ofnone
the key
management
parties related
to any
of them,
has
of
the
key
management
staff,
or
parties
related
to
any
of
them,
has
undertaken
any
material
transactions
undertaken any material transactions with Bridgewater Community Healthcare NHS
with Bridgewater Community Healthcare NHS Foundation Trust.
Foundation Trust.
The Department of Health is regarded as a related party. During the reporting period Bridgewater has had
The
Department
ofofHealth
is transactions
regarded as
a related
party.
During
reporting period
a significant
number
material
(greater
than £1
million)
with the
the Department,
and with other
Bridgewater
has
had
a
significant
number
of
material
transactions
(greater
than
£1 million)
entities for which the Department is regarded as the parent Department. For example :
with the Department, and with other entities for which the Department is regarded as the
parent Department. For example :
Receivables
Payables
31 March
2015
£000
1
November
2014
£000
31 March
2015
£000
1
November
2014
£000
NHS Halton CCG
406
1,494
49
46
NHS St Helens CCG
427
747
39
36
1,148
251
1,161
427
1,022
-
CCGs
NHS Warrington CCG
Page 140
NHS England
Cheshire, Warrington & Wirral LAT
481
-
-
-
Greater Manchester LAT
237
-
-
168
Lancashire LAT
178
-
-
-
Merseyside LAT
173
-
-
11
544
364
1,898
770
-
-
1,418
1,434
26
197
-
24
3,871
4,390
4,426
2,489
NHS Trusts
St Helens and Knowsley NHS Trust
Other NHS Bodies
NHS Pension Scheme
Health Education England
Total
146
CCGs
NHS Halton CCG
Income
2014-15:
For the 5
months
ending 31
March
2015
£000
Expenditure
2014-15:
For the 5
months
ending 31
March
2015
£000
6,972
2
Total
CCGs
NHS Halton CCG
NHS St Helens CCG
NHS Warrington CCG
3,871
4,390
Income
2014-15:
For the 5
months
ending 31
March
2015
£000
4,426
2,489
Expenditure
2014-15:
For the 5
months
ending 31
March
2015
£000
6,972
9,309
9,486
15,456
2
26
0
0
NHS England
Cheshire, Warrington & Wirral LAT
Greater Manchester LAT
Lancashire LAT
Merseyside LAT
2,564
3,710
1,562
3,543
0
0
0
0
NHS Trusts
St Helens and Knowsley NHS Trust
168
1,172
00
1,337
1,337
4,379
4,379
00
54,107
54,107
5,579
5,579
Other NHS Bodies
NHSPension
PensionScheme
Scheme
NHS
HealthEducation
EducationEngland
England
Health
Total
Total
Page 141
In addition, the Trust has had a number of material transactions (greater than £1 million)
Inaddition,
addition,the
theTrust
Trusthas
hashad
hadaanumber
numberof
ofmaterial
materialtransactions
transactions(greater
(greaterthan
than£1
£1million)
million)with
withother
other
In
with
other government
departments
and
other
central andbodies.
local Most
government
bodies. Most
of
governmentdepartments
departmentsand
andother
othercentral
centraland
andlocal
localgovernment
governmentbodies.
Mostof
ofthese
thesetransactions
transactionshave
have
government
these
transactions
have
been with the following entities:
beenwith
with
thefollowing
following
entities:
been
the
entities:
Receivables
Receivables
LocalAuthorities
Authorities
Local
HaltonBorough
BoroughCouncil
Council
Halton
St
Helens
Borough
Council
St Helens Borough Council
WarringtonBorough
BoroughCouncil
Council
Warrington
WiganBorough
BoroughCouncil
Council
Wigan
LocalAuthorities
Authorities
Local
HaltonBorough
BoroughCouncil
Council
Halton
StHelens
HelensBorough
BoroughCouncil
Council
St
Payables
Payables
31March
March
31
2015
2015
£000
£000
11
November
November
2014
2014
£000
£000
31March
March
31
2015
2015
£000
£000
11
November
November
2014
2014
£000
£000
919
919
665
665
741
741
13
13
1,423
1,423
904
904
362
362
771
771
376
376
273
273
286
286
483
483
71
71
-58
58
137
137
2,338
2,338
3,460
3,460
1,418
1,418
266
266
Income
Expenditure
Income
Expenditure
2014-15:
2014-15:
2014-15:
2014-15:
Forthe
the55
Forthe
the55
For
For
months
months
months
months
ending31
31
ending31
31
ending
ending
March
March
March
March
2015
2015
2015
2015
£000 Bridgewater Annual Report
£0002014/15
£000
£000
1,215
1,215
1,968
1,968
47
47
144
144
147
Warrington Borough Council
Wigan Borough Council
Local Authorities
Halton Borough Council
St Helens Borough Council
Warrington Borough Council
Wigan Borough Council
741
13
362
771
286
483
58
137
2,338
3,460
1,418
266
Income
2014-15:
For the 5
months
ending 31
March
2015
£000
Expenditure
2014-15:
For the 5
months
ending 31
March
2015
£000
1,215
1,968
1,314
1,515
47
144
-97
318
6,012
412
9: Audit opinion and report
Page 142
148
9.Appendices
Appendix 1
Sept
Oct
Nov
Dec
Jan
Feb
Mar
Board Meeting (including both public and closed meetings)
Harry Holden
Chairman
I
I
I
I
Karen Bliss
Non-Executive Director I
I
I
I
Steve Cash
Non-Executive Director I AP AP I
Kate Fallon
Chief Executive
I
I
I
I
Baron Frankal
(Left Trust 31 May
I
I
2014)
Sue Musson
(Left Trust 31
AP I
I
I
December 2014)
Bob Saunders
I
I
I
Dorothy Whitaker Non-Executive Director I
I
I
I
Christine Samosa Director of People,
Planning and
I
I
I
I
Development
Colin Scales
Chief Operating Officer I
I
I
I
Mike
Director of Finance
I
I
I
I
Treharrne
Stephen Ward
Medical Director
I
I AP I
Dot Keates
Interim Executive
Nurse (from
I
September 2014)
Executive Nurse/
Dorian
Director of Governance I
I
I
I
Williams
(To September 2014)
Sally Yeoman
I
I
I
Aug
July
June
May
Apr
Board Attendance for year ended 31 March 2015
Total
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
I
AP
I
I
I
I
AP
I
I
I
I
12/12
12/12
9/12
11/12
2/12
AP
AP
I
I
I
6/12
I
I
I
I
I
I
I
I
I
I
I
AP
I
I
I
I
12/12
11/12
I
I
I
I
I
I
I
I
12/12
I
AP
I
I
I
I
I
I
11/12
AP
I
I
I
I
I
I
I
11/12
I
I
I
I
I
AP
I
I
10/12
I
I
I
I
I
I
I
7/12
I
I
5/12
I
I
I
I
I
I
I
12/12
Key
AP - Apologies given
149
Appendix 2
(Left Trust 31
December 2014)
Key
150
Mar
Feb
Jan
Dec
Nov
I
Total
I
I
5/5
I
I
2/5
0/5
I
5/5
4/5
Mar
Feb
I
AP
Jan
Dec
Nov
Oct
I
I
Sept
Aug
July
I
I
June
I
I
Nominations and Remuneration Committee (Held on ad-hoc basis)
Harry Holden
Chairman
I
Dorothy Whitaker Non-Executive Director
I
Bob Saunders
I
Karen Bliss
I
Steve Cash
AP
Baron Frankal
(Left Trust 31 May
2014)
Sally Yeoman
I
Sue Musson
Oct
Sept
Aug
July
I
May
Apr
Audit Committee
Karen Bliss
I
(Chair)
Steve Cash
(appointed to
Committee in
December 2014)
Baron Frankal
(Left Trust 31 May
AP
2014)
Bob Saunders
June
May
Apr
Register of Director Attendance at Committee meetings for
year ended 31 March 2015
Total
I
I
I
I
I
I
AP
I
I
AP
3/3
2/3
3/3
3/3
1/3
I
I
3/3
I
Appendix 2
I
I
I
I
I
I
I
AP
I
I
I
I
I
I
I
AP
AP
I
I
I
I
I
AP
I
I
I
I
I
7/8
8/8
7/8
5/8
I
I
I
I
I
I
I
8/8
I
I
I
I
I
I
I
I
AP
Aug
Mar
7/8
Feb
I
Jan
I
Dec
I
Nov
I
Oct
July
I
Sept
June
I
Aug
May
AP
30 Mar
Total
I
I
AP
I
I
AP
I
I
7/9
I
I
I
AP
I
I
I
I
8/9
I
I
I
I
I
I
I
I
9/9
I
I
I
AP
I
AP
4/9
I
I
I
I
I
I
I
9/9
I
I
I
I
I
I
I
I
9/9
I
AP
I
I
I
I
I
I
8/9
I
I
I
I
I
AP
I
AP
7/9
AP AP
Nov
2 Mar
6/8
6/8
Jan
I
I
Dec
AP
I
Oct
I
I
Sept
I
AP
Feb
4/8
July
Trust Efficiency Assurance Committee
Steve Cash
Non-Executive
I
(Chair)
Director
Karen Bliss
Non-Executive
I
Director
Sally Yeoman
Non-Executive
I
Director
Kate Fallon
Chief Executive
AP
Christine Samosa Director of
People, Planning
I
and
Development
Colin Scales
Chief Operating
I
Officer
Mike Treharne
Director of
I
Finance
Steve Ward
Medical Director
I
May
Apr
Quality and Safety Committee
Bob Saunders
I
(Chair)
Karen Bliss
Kate Fallon
Chief Executive
I
Sally Yeoman
Non-Executive Director AP
Dot Keates
Interim Executive
Nurse (from
I
September 2014)
Dorian Williams Director of
Governance/Executive
I
Nurse (To September
2014)
Steve Ward
Medical Director
AP
Colin Scales
Chief Operating Officer I
Total
June
Apr
Register of Director Attendance at Committee meetings for
year ended 31 March 2015 (continued)
Key
151
Appendix 3
Council of Governours Meetings (from the establishment of the Trust as an FT - 1 November 2014
Harry Holden
Chairman
I
I
Karen Bliss
I
AP
Steve Cash
I
AP
Kate Fallon
Chief Executive
I
I
Baron Frankal
(Left Trust 31 May 2014)
Sue Musson
(Left Trust 31
AP AP
December 2014)
Bob Saunders
I
AP
Christine Samosa
Director of People,
Planning and
I
I
Development
Colin Scales
Chief Operating Officer
I
AP
Mike Treharrne
Director of Finance
I
AP
Stephen Ward
Medical Director
I
AP
Dorothy Whitaker
I
Dorian Williams
Executive Nurse/
Director of Governance
(To September 2014)
Sally Yeoman
I
AP
Dot Keates
Interim Executive Nurse
I
I
(from September 2014)
John Prince
Irene Deakin
Nano Nagle Hill
Diane McCormick
Dave Oldham
Sue Irvine
Peter Appleby
Rita Chapman
Bill Harrison
Lead Governor and Public
Govenour - Wigan
Public GovernorCommunity Dental
Public Governor - Halton
Public Governor - Rest of
England
Public Governor St. Helens
152
Mar
Feb
Jan
Dec
Nov
Oct
Sept
Aug
July
June
May
Apr
Register of Director and Governor Attendance at Council of
Governor meetings for year ended 31 March 2015
I
AP
AP
I
I
I
I
I
AP
I
I
I
I
I
I
AP
AP
AP
I
AP
I
AP
AP
I
I
AP
I
I
I
I
I
I
AP
AP
I
I
I
Appendix 3
Mar
I
I
AP
AP
AP
I
I
I
AP
I
I
I
I
I
AP
AP
AP
I
I
I
I
I
I
I
I
I
I
I
I
AP
AP
I
AP
AP
I
AP
I
I
I
I
I
I
AP
AP
I
AP
AP
AP
AP
I
I
I
I
AP
AP
I
I
I
I
AP
I
AP
AP
I
Feb
Dec
AP
Jan
Nov
Oct
Sept
Aug
July
June
May
Apr
Register of Director and Governor Attendance at Council of
Governor meetings for year ended 31 March 2015 (continued)
Board Meeting
Derek Maylor
Jean Ball
Liz Matthews
Derek Saunders
G. Scott Baron
Julie Atherton
Sylvia Cunliffe
James Roberts
Gary Young
Charlotte Dixon
Carol Lever
Steven Lowe
Angela Akers
Vikki Morris
Corina Cassey
Hardman
Karen Worthington
Clr J Pearson
Janette Grey
Clr Keith Cunliffe
Clr Peter Lloyd
Jones
Clr Judith Guthrie
Mick Taylor
Public Governour
- Warrington
Public Governour
- Warrington
Public Governour
- Warrington
Public Governour
- Warrington
Public Governour Wigan
Staff Governour - Clinical
Support Services
Staff Governour - AHP
Staff Governour - AHP
Staff Governour -Dental
Staff Governour
-Non-Clinical Support
Staff Governour - Nursing
and Midwifrey
Staff Governour - Nursing
and Midwifrey
Partner Governour
- St. Helens
Partner Governour
Higher Education
Partner Governour
- Wigan
Partner Governour
- Halton
Partner Governour
- Warrington
Partner Governour
- Voluntary Sector
153
154
Quality Account
2014/15
Bridgewater Quality Account 2014/15
1
2
Contents
Page
Part 1 - Statement on Quality from the Chief Executive
Statement on Quality by Chief Executive
5
A bit more about us.....
7
Part 2 - Priorities for Improvement and Statements of Assurance from the Board
Review of Progress against 2014/15 Priorities for Improvement
8
Priorities for Improvement in 2015/16
12
Statements of Assurance from the Board
14
Reporting against Core Indicators page 19
Part 3 - Review of Quality Performance
Quality of Services in 2014/15
25
Trust Quality Measures
25
Patient Experience28
Patient Story28
Patient Survey and Friends and Family Test Results
29
Patient Partners29
Patient Advice and Liaison Service
30
Complaints31
Staff Engagement, Health & Wellbeing
32
Staff Engagement32
NHS Staff Survey 2014
33
Staff Health & Wellbeing
34
Performance Development Reviews
35
Staff Turnover35
Responsible Officer Compliance
36
Education & Professional Development
36
Mandatory Training36
Continuing Professional Development
36
Competence Frameworks37
Pre-Registration37
Forward Planning37
Leadership Programme and the Bridgewater Quality Improvement 38
Programme Library Strategy
38
39
Delivering Same Sex Accommodation
40
Incident reporting40
Never events44
Central Alert System
45
Pressure Ulcers45
Workforce Planning46
Coroner’s Cases46
3
Contents
Page
Infection Prevention and Control
47
Safeguarding53
National Institute for Health and Care Excellence
54
Clinical Audit56
Research59
Care Quality Commission
59
St Helens Clinical Commissioning GroupReview of Newton Hospital 60
Medicines Management61
Information Governance64
Emergency Preparedness, Resilience and Response
65
Partnership Working65
Service Improvements70
Listening into Action
76
Developing our Organisational Culture
77
Quality, Innovation, Productivity and Prevention
78
Clinical Strategies79
Strategy Days79
Quality Seminars80
Health Improvement Programmes
80
Midwifery81
Community Dental82
Walk in Centres
83
Out of Hours
83
Waiting Times84
Foundation Trust Application
87
Monitor Regulation87
88
Monitoring the Quality of Services across Bridgewater
88
Quality Impact Assessment Process
89
Actions taken to address Francis Report Recommendations
89
Actions taken to address Freedom to Speak up Recommendations
89
Sign up to Safety
89
Open and Honest Care
89
NHS Safety Thermometer
90
Internal Audit91
Stakeholder Involvement in the Development of our Quality Account
93
Appendices
Appendix A – Children’s Immunisations for Quality Account
102
Appendix B – Statement of Directors’ Responsibilities
103
Appendix C – Auditors Report
104
4
Statement on Quality
by Chief Executive
I am delighted to write this Statement on Quality for our 2014/15 Quality Account.
This has been a very positive year as the organisation became one of the first two community
trusts to be awarded Foundation Trust status. This was a momentous occasion and marked
the achievement of one of our strategic objectives. I would like to once again take this
opportunity to thank all the staff for their hard work and dedication to delivering high quality
patient care, without whom this would not have been possible. This account covers the entire
financial year.
I want all colleagues to be involved in developing and implementing the plans we have; this
is why we embarked on the Listening into Action programme. The Big Conversations were
an opportunity for staff to talk to me about what they felt the biggest blockers to great patient
care were, and what actions we should take to overcome or fix them. Staff were not backward
in coming forward, with a lot of lively and passionate discussion at each event. We have been
able to make some “quick wins” to address the concerns raised by staff. For example:
• A text messaging reminder service for patients has been implemented across MSK/
CATS to assist in reducing the number of unutilised treatment slots as a result of
patients not turning up for their appointment
• The introduction of teleconferencing facilities Trust-wide to enable staff to do their jobs
properly, help them manage their time more effectively, and reduce the amount of
miles they are expected to travel. Each directorate now has its own teleconferencing
line for all staff to use.
5
We take patient feedback seriously and each month a Patient Story is presented to the
Board. These stories portray a very strong message about the care we provide and we
always strive to make improvements when that care is not as we would like it to be. The Trust
receives relatively few complaints. However, any areas for improvement are taken very
seriously by the Board, managers and all our staff and we endeavour constantly to improve
the quality of care we deliver.
It is very pleasing to note that 99% of our patients expressed their overall satisfaction with
their care and treatment which is up from 98% at the end of March 2014.
As Chief Executive I am confident that the Trust provides a high quality service and that this
Quality Account demonstrates this. To the best of my knowledge the information in this
account is accurate and fairly reflects the quality of the care we deliver.
Colin Scales
6
A bit more about us…
Bridgewater provides high quality community and specialist services to 855,848 people
covering:
• Runcorn & Widnes (Halton)
• St Helens
•Warrington
• Wigan Borough
• Community Dental (provides services in all of the above areas plus Bolton, Tameside,
Trafford, Glossop, Stockport and Western Cheshire)
The majority of our services are delivered in patients’ homes or at locations close to where
they live, such as clinics, health centres, GP practices, community centres and schools.
As a provider of both mainstream and specialist care our role is to focus on providing cost
effective NHS care by keeping people out of hospital and supporting vulnerable people
throughout their lives.
As a dedicated provider of community services our strategy is to bring more care closer to
home – this means providing a wider range of services in community settings to keep people
healthier for longer and developing more specialist services to support people to live
independently at home.
We employ 3,400 staff and have an income of £140 million which comes from our
commissioners; including Clinical Commissioning Groups (CCGs), NHS England and Local
Authorities.
• NHS Warrington CCG represents 26 GP practices, acting on behalf of over 212,901
patients living in Warrington
• NHS Halton CCG represents 17 GP practices, acting on behalf of over 125,892
patients living in Halton
• NHS St Helens CCG represents 37 GP practices, acting on behalf of over 194,758
patients living in St Helens
• NHS Wigan CCG represents 65 GP practices, acting on behalf of over 322,297
patients living in Wigan
On an average day we care for:
•
•
•
•
•
Approximately 9500 patients
409 people in our walk-in centres
27 people in our community hospital (Newton)
2190 supported by our district nurses
290 people in our community dental services
7
Review of Progress against 2014/15 Priorities for
Improvement
Quality Improvement
priorities in 2014/15
Measures of
success
Update and Assurance
Outcome
Ensuring we are safe
Open and Honest Care –
Improve the accuracy of
pressure ulcer reporting.
Safer Staffing: appropriate levels
and skills of staff to
ensure quality of care and patient
safety. Develop a
standardised caseload
weighting tool that is
understood and used
consistently across all district
nursing teams and boroughs.
Effective reporting will identify the
need for redeployment or
additional resources.
Monthly pressure
audit reports
Quarterly dashboard produced and monitored by
QMG.
Met
Incident reports for
pressure ulcers
Reported monthly in the Integrated Performance
Report (IPR) and nationally for Open and Honest
Care on NHS Choices.
Met
National publication
of our pressure
ulcer numbers
Reported monthly in the IPR and nationally for Open
and Honest Care on NHS Choices.
Met
Quarterly safer
staffing and caseload
weighting reports
Safer staffing reports produced monthly and
submitted to Board.
Met
Monitoring of
Caseload weighting
Standards agreed and peer audit in progress.
Met
Measure the impact
using standardised
clinical assessment
tools alongside
parental
questionnaires
Integrated Research Application System ethics was
granted.
The Eczema Expert pilot was delayed by 3-6 months
due to issues relating to whether all the contents
in the box are included in the Greater Manchester
formulary/available without prescription.
Increase in the
number of Patient
Partners involved with
service redesigns
There were 170 patient partners at the end of 2013/14.
There were 195 patient partners at the end of 2014/15.
Met
Maintain or improve
the overall patient
experience score
At the end of 2013/14 98% of patients expressed
overall satisfaction with their care and treatment.
At the end of 2014/15 99% of patients expressed
overall satisfaction with their care and treatment.
Met
Increased
understanding about
what is most
important to those who
use our children and
young people services
A parent reported outcomes and experience measure
has been developed and will be routinely
implemented in Warrington Borough from April
2015 to provide both assurance and feedback for
services to inform continuous improvement.
Met
Ensuring we are effective
To develop an innovative,
evidence based, self-care
approach to the treatment of atopic
eczema in children.
Not Met
Ensuring we are caring
Improving patient experience and
involvement.
Understand more about the
emotional and functional outcomes
of care for children and young
people through direct family
engagement techniques. We are
interviewing families and will be
developing a feedback tool which
8
Improvement (continued)
Quality Improvement
Measures of
success
Outcome
can capture and report on the
question ‘what difference did we
make?’ in relation to functional and
emotional outcomes.
Engagement with patients with
disabilities and their carers to
work collaboratively with them
to improve patient experience for
patients with disabilities within
community dental services.
Increased
understanding
about what is
most important to
patients with
disabilities and
their carers who
use our
community dental
services
Measures of success have been achieved in that we have
found out what is important for our patients and acted on
it. However this work needs to be on-going and it is now
embedded in what we do routinely.
Met
Ensuring we are responsive
New birth visit
contacts by
health visitors
Warrington: (2013/14 – 48.3%) 2014/15 – 49.6%£
Wigan: (2013/14 – 39.4%) 2014/15 – 37.9%
Halton: (2013/14 – 27.99%) 2014/15 – 34.58% £
St Helens: (2013/14 – 30.85%) 2014/15 – 42.77%£
Partially
6-8 week breast
feeding rates
Warrington: (2013/14 – 36.6%) 2014/15 – 37.3%£
Wigan: (2013/14 – 31.2%) 2014/15 – 28.4%
Halton: (2013/14 – 21.71%) 2014/15 – 20.72%
St Helens: (2013/14 – 21.79%) 2014/15 – 21.01%
Partially
3 month breast
feeding rates
(development
target)
The 3 month breast feeding rates are not currently collated.
The current emphasis is on improving the initial and 6-8 week
breast feeding rates.
Not Met
IV therapy delivered in Warrington, Halton, St Helens and
Knowsley.
Early supported discharges (ESDs)
Q1 Early discharges = 107
PART (Paediatric Acute Response Team) have also facilitated
5 ESDs since the service commenced in May 2014.
Met
Number of
hospital
admissions
avoided
IV therapy delivered in Warrington, Halton, St Helens and
Knowsley .
Number of admissions avoided
Q1 Admissions avoided = 82
Met
Nationally agreed
health check
requirements will
be implemented
All patients received into custody are requested to attend an
annual health check.
Met
To implement a comprehensive
annual health check across all
three prison sites for offenders who
have a learning disability.
£
£
£
Developing out of hospital services Reduced length of
to deliver intravenous therapy (IV) stay in hospital
in the community.
£
To improve the current breast
feeding rates across the
boroughs we serve by giving new
mothers the opportunity to sign up
to the Flo initiative which provides
them with on-going support and
motivational texts whilst they are
breast feeding.
9
Improvement (continued)
Quality Improvement
Measures of
success
Number of annual health
checks carried out
To ensure processes are in
place to provide on-ward
referral, sign-posting and
advice to patients identified as
potentially having dementia,
and their carers, within our
community nursing and
in-patient services.
Audit completed and all the required health checks have
been carried out as required.
Outcome
Met
Questions from the Six
6CIT contained within all community nursing
Item Cognitive
assessment documentation across Bridgewater.
Impairment Tool (6CIT)
(nationally recognised
cognitive impairment test)
to be incorporated into
initial screening
assessment to ensure all
patients are screened
Met
Devise borough
specific information packs
regarding local services
to support patients and
carers
E-directory of services and voluntary agencies available
by borough to support patients and carers developed on
intranet.
Resource links are available as part of the training.
Met
Develop a passion for
supporting people
with dementia by
identifying and utilising
“dementia champions” to
lead the project
Dementia champions identified at service level within
community nursing. There are between 2-4 champions
in each borough.
Dementia friend identified within in-patient services.
The champions are a resource for staff if required.
The dementia friendly training has now been
superseded by the e-learning.
Met
Develop tiered levels
of dementia awareness
by working with learning
and development to
establish a baseline
of work-force current
training and awareness
levels and establish a
training needs analysis
and training plan, as
appropriate
Dementia training is on the community nursing
workforce training needs analysis and levels of training
are monitored by the Learning and Development Team.
Bridgewater dementia training figures returned to NHS
North West are Q1 = 585, Q2 = 226, Q3 = 392 and
Q4 178 Total = 1381
Met
Our risk descriptions will
be the same as
our incident
descriptions
Risk management training delivered on a monthly basis
which has more accurately identified patient safety
incidents. All incident cause groups (used for aggregate
reporting) have been re-described during 2014/15 but
implemented in April 2015 with the risk types being
updated in line with these during April 2015.
Not Met
More accurately
documented risk
assessments and
consequently a potential
reduction in harm caused
Risk management training delivered on a monthly basis.
Met
Ensuring we are well-led
Prevent the risk of future
incidents by improving the
way in which we monitor risks
by more closely aligning our
risk and incident data.
10
The priorities for 2014/15 have been monitored throughout the year. As we move into
2015/16 the Trust will ensure that these areas continue to be monitored as part of the
Trust quality monitoring processes. The three areas not completed will continue to be
monitored and reported on in next year’s account.
Quality Improvement
To develop an innovative evidence base,
self-care approach to the treatment of
atopic eczema in children
Prevent the risk of future incidents by
improving the way in which we monitor
risks by more closely aligning our risk
and incident data
To improve the current breast feeding
rates across the boroughs we serve by
giving new mothers the opportunity
to sign up to the Flo initiative which
provides them with on-going support and
motivational texts whilst they are breast
feeding
Outcome
Comment
Not Met
This development will continue into
2015/16 and the Trust is working
partnership with the Clinical
Commissioning Group to develop the way
forward for the benefit of the children.
Not Met
This was not completed by the end of
2014/15. The new incident cause groups
will be in place from April 2015/16.
Partially Met
In light of the 2014/15 data we are
working with the commissioners to
develop enhanced service specifications
for infant feeding.
11
Priorities for Improvement in 2015/16
During 2015/16 the Trust is committed to further develop the culture in line with our mission:
to improve local health and promote wellbeing in the communities with serve.
As we start 2015/16 the Trust is entering a new exciting phase of its journey and the existing
Quality Strategy will be reviewed and refreshed to meet the changing environment of
community care in line with the Five Year Forward Plan, and national initiatives that have
identified improvement in quality of care and the developments in the organisational
structure. The new Quality Strategy will cover the next three years. The Board will review and
approve this new strategy in August 2015.
To continue our quality journey we will build on the positive culture where quality of care can
develop. The Trust will ensure through our revised strategy that we:
• Have clearly aligned goals and objectives at every level
• Identify shared values and behaviours across the Trust
• Provide a learning and improvement environment
This strategy will be further developed and defined during 2015/16 in consultation with
patients, governors and partner organisations. The Trust will have an implementation plan for
our Quality Strategy. The Quality and Safety Committee will receive quarterly reports on the
implementation of this plan via the Quality Management Group. Our progress on delivering
the priorities will be reported in next year’s Quality Account.
Quality Priority 1 - Sign up to Safety
‘Sign up to Safety’ aims to deliver harm free care for every patient, every time, everywhere. It
champions openness and honesty and supports everyone to improve the safety of patients.
We have developed our patient safety improvement plan for 2015/16 based on the ‘Sign up
to Safety’ actions and we have committed to the following five ‘Sign up to Safety’ pledges:
1. Putting safety first: commit to reduce avoidable harm in the NHS by half and make public
the goals and plans developed locally
2. Continually learn: make our organisation more resilient to risks, by acting on patient
feedback and by constantly measuring and monitoring how safe our services are
3. Being honest: be transparent with people about our progress to tackle patient
safety issues and support staff to be candid with patients and their families if something
goes wrong
4. Collaborating: take a lead role in supporting local collaborative learning so that
improvements are made across all of the local services that patients use
5. Being supportive: help our people understand why things go wrong and how to put them
right. Give them the time and support to improve and celebrate the progress
12
Quality Priority 2 - Improvement in the handling of serious and untoward incidents
Following publication of NHS England’s revised framework for the handling of serious and
untoward incidents, the Risk Team and Senior Managers agreed a programme of work for
2015/16. This programme of work will assist in the implementation of the new framework and
address the:
• Late submission of Root Cause Analysis (RCA) documents during 2014/15
• Quality of data on the Strategic Executive Information System (STEIS)
• Internal quality control of the “sign off “ of completed SUI investigations
The programme of work has been discussed with each of our Clinical Commissioning
Groups.
Quality Priority 3 – NHS Safety Thermometer improvements in care
The Trust performs well against aspects of the NHS Safety Thermometer in comparison to
other NHS community services. Nevertheless, we strive to continuously improve care against
these key areas. During 2015/16, we will further develop clinical delivery and training in the
following areas:
• Pressure ulcer management:
• To continue the reporting of the pressure ulcer monitoring tool and analysis of the
data
• To reduce the incidents of avoidable pressure ulcers in line with the new national
framework
• To continue to work in partnership with local health providers to improve the health
economy pathway
• Falls management in in-patient bed areas:
• To roll out the FallSafe programme to all in-patient and intermediate care units
• To monitor the effectiveness of the programme and reduction in the number of
falls incidents
• Undertake regular audits on falls during the 2015/16
• Medication safety:
• Robust monitoring of omitted or late doses of medication by improved incident
reporting, ensuring lessons learnt are embed into practice and policy and training
put in place
• Increase the reporting of medication near misses in order to identify lessons learnt
and thus reduce medication incidents
• Improve the uniformity of medication incident data reported via the Trusts
electronic incident reporting system in order to improve the analysis of incidents
Quality Priority 4 - Newton Hospital Vision and Strategy
Following a review by the CQC and St Helens CCG, the Trust is developing a vision and
strategy working in liaison with the CCG; due for presentation at the Trust Board in Quarter 2.
13
How were they chosen?
Patient safety is a top priority for the Trust. We have signed up to the ‘Sign up to Safety’
initiative, which is designed to help realise the ambition of making the NHS the safest
healthcare system in the world.
Quality priorities 2 and 3 have been identified following discussions with a range of staff at a
Management Away Day and they are in line with our top three reported incidents. The Clinical
Commissioning Groups (CCGs) have identified these areas as priorities.
With respect to quality priority 4, the Trust is working with St Helens CCG to determine the
strategic direction of Newton Hospital with the aim of improving patient pathways and
partnership working with the wider health economy.
Statements of Assurance from the Board
Review of Services
During 2014/15 Bridgewater Community Healthcare NHS Foundation Trust provided and/or
sub-contracted 129 relevant health services.
Bridgewater Community Healthcare NHS Foundation Trust has reviewed all the data available
to them on the quality of care in 100% of these relevant health services.
The income generated by the relevant health services reviewed in 2014/15 represents 93.5%
of the total income generated from the provision of relevant health services by Bridgewater
Community Healthcare NHS Foundation Trust for 2014/15.
Audit
During 2014/15, one national clinical audit and one national confidential enquiry covered
relevant health services that Bridgewater Community Healthcare NHS Foundation Trust
provides.
During that period Bridgewater Community Healthcare NHS Foundation Trust participated in
100% national clinical audits and 100% national confidential enquires of the national clinical
audits and national confidential enquires it was eligible to participate in.
The national clinical audits and national confidential enquires that Bridgewater Community
Healthcare NHS Foundation Trust was eligible to participate in during 2014/15 are as follows:
Title
The National Audit of Intermediate Care
The National Confidential Enquiry – Sepsis Study
organisational questionnaire
Audit Requirements
Services distributed a service user questionnaire. This
phase of the audit did not require cases to be submitted
This study was an organisational questionnaire and did not
require cases to be submitted
No national clinical audit reports published during 2014/15 were relevant to the services that
Bridgewater Community Healthcare NHS Foundation Trust provides and therefore none were
eligible to be reviewed.
14
The reports of 30 local clinical audits were reviewed by the provider in 2014/15 and
Bridgewater Community Healthcare NHS Foundation Trust intends to take the following
actions to improve the quality of healthcare provided:
Title of Audit
Audit of Catheter Care (joint audit with
Wrightington, Wigan and Leigh NHS
Foundation Trust)
Key Findings
11 standards in the audit. 8/11
achieved compliance levels of 80% or
more.
The remaining 3 standards that
achieved less than 80% are:
1. samples followed up within 3 days
2. wound swab if signs of infection
3. supra-pubic catheters not to be
changed in first 6 weeks
Actions
Improve use of standard forms such
as CCP11 (care plan form) to ensure
comprehensive documentation and
prompts.
Minor redesign of catheter passport
as suggested by patient feedback.
Re-audit with clarification around two
questions that results indicate may
have been misinterpreted by auditors.
The patient feedback aspect of the audit
supports the audit findings except that
the patient health records show 80% of
patients were given catheter
passports, whereas patient feedback
figure is 50%. This difference may
be due to the fact that not all patients
returned the questionnaire.
Audit of In-patient Falls Prevention
(Newton Community Hospital)
Falls and fall-related injuries are a
common and serious problem for older
people. People aged 65 and older have
the highest risk of falling, with 30% of
people older than 65 and 50% of
people older than 80 falling at least
once a year.(NICE 2013)
Patient health records were assessed
using NICE standards for inpatient
falls:
• 100% of patients had a falls
assessment within 6 hours of
admission
• All patients had an agreed care
plan that had been reviewed.
However only 40% were
multifactorial with timescales
• 88% of patient and their carers
received verbal advice on the ward
on falls prevention techniques
• 79% of patients received further
verbal advice before discharge on
falls prevention strategies
Audit results reflect a lot of
improvement work undertaken prior
to audit; however the audit has shown
some areas for improvement.
The RCP FallSafe initiative with
pathway and care bundles is being
adapted and will be launched within
the next 6 months across all
bed-based services provided by
Bridgewater. This will provide a more
robust process for both patients and
staff.
A further audit will be undertaken 3
months after implementation of
FallSafe to ensure that all NICE
standards have been achieved.
15
Title of Audit
Key Findings
Actions
• Only 1 person had evidence of
being offered and referred to a
falls prevention service
• Only 19% of patients had a lying
and standing blood pressure taken
(local & RCN standard)
• 81% had a home assessment
documented in the notes. Patient
feedback showed this to be 100%
Further patient feedback:
• 100% of patient said they were
treated with dignity and respect at
all times
• All patients rated the care as very
good or excellent
Out of the 30 audits, 19 have action plans for development and 11 achieved the standards of
care. It should be noted that a good clinical audit programme will focus on areas identified
for potential improvement. This means that most of the topics being audited for the first time
are expected to have action plans for improvement. A portion of the clinical audit programme
will consist of re-audits that have been through cycles of improvements and been re-audited
until standards are met. Some examples of audits that have met the standards are:
Title of Audit
Key Findings
Audit of assessment of dementia at Significant improvements from initial audit as shown below.
Newton Community Hospital
(cycle 2)
100% assessed using evidence based tool (6CIT), of these 84% within 6 hours
of admission. An increase of 61% from previous audit. The service added the
recording the time of the 6CIT assessment which provided the
evidence that 84% were being assessed within 6 hours. The previous audit
highlighted that the time was not recorded and there was only evidence of
‘assessment within 6 hours’ in 39% of cases.
91% of patients had the outcome of the 6CIT assessment acted upon. In the
previous audit this was 80%.
The initial audit findings showed that only 17% had information regarding the
assessment contained within the GP letter, within this audit cycle this had
increased to 96%.
This re-audit shows that standards audited are now all within an acceptable
level.
Audit of Insulin Safety in Community
Nursing
This audit was piloted in the Wigan borough and then repeated across all areas
of Bridgewater. As the clinical standards of care were met, there is no need to
re-audit but on-going monitoring will be undertaken through incident reporting.
There were four parts to this audit. Three parts were undertaken during a home
visit to administer insulin to patients.
16
Title of Audit
Key Findings
The fourth part related to staff training.
1. Nurses were observed: all patients were noted to have their blood glucose
checked or were known to be stable prior to the administration of the
insulin. All staff were observed administering the insulin in a safe manner.
2. Patient health records were audited which showed that all patients had an
insulin care plan. All prescription sheets met record keeping standards for:
- Dose in units (not abbreviated)
-Frequency
- Drug name
- Batch and expiry
3. The patient was asked whether they had been offered or taught to
administer the insulin, either self-administer or a family member/carer.
The patient was also asked whether it was easy enough to get insulin
medication from their own GP.
-
-
In 16% of patients, it is not known whether they had been taught or offered
self -monitoring or self -administration skills. The auditor either did not ask
the patient or did not complete the audit form properly during the visit.
A small number of patients (6%) said that it was not easy enough to get
insulin medication; they blamed the pharmacy or their own GP.
4. 47% of staff said they had not received training on insulin. The largest
number of staff saying they had received training was at Wigan (62%),
and the lowest at Halton (4%). The disparity of training is a known issue
across the service and is already under review.
Participation in Clinical Research
The number of patients receiving relevant health services provided or subcontracted by
Bridgewater Community Healthcare NHS Foundation Trust in 2014/15 that were recruited
during that period to participate in research approved by a research ethics committee was 87.
Goals agreed with Commissioners - Use of the Commissioning
for Quality and Innovation (CQUIN) Payment Framework
A proportion of Bridgewater Community Healthcare NHS Foundation Trust income in 2014/15
was conditional on achieving quality improvement and innovation goals agreed between
Bridgewater Community Healthcare NHS Foundation Trust and any person or body they
entered into a contract, agreement or arrangement with for the provision of relevant health
services, through the CQUIN payment framework.
The Trust developed Commissioning for Quality and Innovation schemes with each of the
four main boroughs, Halton, St Helens, Warrington and Wigan Clinical Commissioning Group
payment framework. Targets were also agreed separately with Specialised Commissioning
for our Offender Heath services.
The framework aims to embed quality within commissioner-provider discussions and to
create a culture of continuous quality improvement, with goals that are agreed as part of
annual contracts.
17
Further details regarding the agreed goals for 2014/15 and for the following 12 month period
is available electronically at www.bridgewater.nhs.uk/aboutus/foi/cquin/
During 2014/15 the Trust attracted 2.5% of our contract value as CQUIN payments. The total
payment available within the CQUIN framework during the period was £2907k.
The monetary total for the associated payment in 2013/14 was £2948k.
What others say about the Provider - Statements from the CQC
Bridgewater Community Healthcare NHS Foundation Trust is required to register with the
Care Quality Commission and its current registration status is full and unconditional
registration.
The Care Quality Commission has not taken enforcement action against Bridgewater
Community Healthcare NHS Foundation Trust during 2014/15.
Bridgewater Community Healthcare NHS Foundation Trust has not participated in any special
reviews or investigations by the CQC during the reporting period.
NHS Number and General Medical Practice Code Validity
Bridgewater Community Healthcare NHS Foundation Trust submitted records during 2014/15
to the Secondary Uses service for inclusion in the Hospital Episode Statistics which are
included in the latest published data.
The percentage of records in the published data which included the patient’s valid NHS
number was:
• 99.9% for outpatient care
• 98.5% for accident and emergency care
The percentage of records in the published data which included the patient’s valid General
Medical Practice code was:
• 97.4% for outpatient care
• 98.5% for accident and emergency care
Information Governance Toolkit Attainment Levels
The Information Governance Toolkit (IGT) provides an overall measure of the data quality
systems, standards and processes. The score a trust receives is therefore indicative of how
well that trust has followed guidance and good practice. An audit was conducted by
Mersey Internal Audit Agency (MIAA) during January/February 2015 to evaluate and validate
the Trust’s self-assessed scores. The final report from MIAA granted the Trust ‘significant
assurance’.
Bridgewater Community Healthcare NHS Foundation Trust Information Governance
Assessment Report overall score for 2014/15 was 66% and was graded green and validated
as satisfactory.
18
Clinical Coding Error Rate
Bridgewater Community Healthcare NHS Foundation Trust was not subject to the payment by
results clinical coding audit during 2014/15 by the Audit Commission.
Statement on Relevance of Data Quality and your actions to
improve your Data Quality
Bridgewater Community Healthcare NHS Foundation Trust will be taking the following action
to improve data quality.
The Trust recognises the need to ensure that all Trust and clinical decisions are based on
sound data and has a number of controls in place to support the process of ensuring high
quality data.
The Trust has used MIAA to audit performance reporting since May 2011. The overall
objective of the audits is to provide assurance that the Trust has an effective processcontrolled system for performance reporting.
The Trust has implemented its data consistency programme that aims to ensure a consistent
One Bridgewater approach to recording data across all its boroughs.
A data consistency implementation group is chaired by the Medical Director, who oversees
data consistency progress aligned with service redesign and SystmOne roll-out across the
Trust.
Reporting against Core Indicators
Since 2012/13, NHS Foundation Trusts have been required to report performance against a
core set of indicators. Bridgewater Community Healthcare NHS Foundation Trust is able to
provide data related to the following relevant indicators.
Core Indicator
The percentage of patients aged 16 or
over, that were readmitted to a hospital
which forms part of the Trust within
28 days of being discharged from a
hospital which forms part of the Trust
during the reporting.
2014/15
2%
2013/14
0.3%
There were 343 discharges and 7
readmissions within 28 days
There were 367 discharges and 1
readmission within 28 days
NB – The above figures relate to Newton Community Hospital which is an intermediate care
facility and only admits patients aged 18 or over. Therefore, direct comparison with the
national comparative data below is not possible.
The National average for Emergency 28 day Readmissions for patients over 16 years of age
for the 2011/12 reporting period (latest available data) is 11.08% and the North West average
is 13.02%.
19
Bridgewater Community Healthcare NHS Foundation Trust considers that this data is as
described for the following reasons;
Days to readmission back into Newton Community
Hospital
16
1
5
1
23
4
22
Reason
1 x Fall
Reduced mobility
Chest infection
Patient unable to cope at home
Chest Pain
Reduced Mobility
Reduced Mobility
Bridgewater Community Healthcare NHS Foundation Trust has taken the following actions to
improve this number, and so the quality of its services, by:
• Continuation of the two week Outreach Service to provide support to patients in their
own homes
• Commencement of daily Multidisciplinary (MDT) Team Planning Meetings
• Commencement of three x weekly MDT ward rounds
• Commencement of local team analysis of readmissions to enable learning and
improvement
Core Indicator
% of staff that would
recommend the Trust
to friends and family in
need of treatment. (Q12d
NHS Staff Survey)
% of staff that would
recommend the Trust to
friends and family as a
place to work.
(Q12c NHS Staff Survey)
Bridgewater
2013
Bridgewater
2014
National
Average for
Community
Trusts
Highest
Community
Trust
Lowest
Community
Trust
65%
70%
70%
83%
62%
47%
49%
53%
73%
41%
The Bridgewater Community Healthcare NHS Foundation Trust considers that this data is as
described for the following reasons:
• There have been major organisational changes affecting staff during 2013 and 2014.
It is recognised that change of this nature and scale can affect staff morale and their
perceptions of the organisation. Work has been on-going during 2014 to try to
improve this and there has been a slight improvement in the score to reflect this.
20
The Bridgewater Community Healthcare NHS Foundation Trust intends to take the
following actions to improve this score, and so the quality of its services by:
• Recognising that there is a slight improvement in this result and continuing to work
towards improving this score by proactively monitoring the staff survey action plans
that will be developed with staff involvement and focusing on the results of the
quarterly family and friends survey results.
• Various initiatives have been put into place to work further on staff engagement and
these include: updating the intranet site, Director Walkabouts, Professional Forums,
Chief Executives Blog, Team Brief and Trust Bulletin, Star of the Month, Annual Staff
Awards and “you said, we did…..are doing” cascades.
Core Indicator
Percentage of patients who were
admitted to hospital (Newton Hospital
only) and who were risk assessed for
venous thromboembolism during the
reporting period.
VTE Screening Performance
Bridgewater Average Full Year
National Average All Trust
(April 2014 - Jan 2015)
Greater Area Manchester Team
(April 2014 - Jan 2015)
Community Trust All
(April 2014 - Jan 2015)
2014/15
2013/14
98.75%
99.46%
Average % of VTE
Patients Screened
99.64%
Lowest Performance %
Highest Performance %
94.40%
100%
96.09%
87.42%
100%
96.17%
93.68%
100%
98.53%
95.14%
100%
(NB – the data in the above table from UNIFY2 relates to both Newton Hospital and our
intermediate care service in Padgate House. Therefore a direct comparison is not possible.
The table has been added to provide indicative data regarding the national average and the
highest and lowest scores for this core indicator).
Bridgewater Community Healthcare NHS Foundation Trust considers that this data is as
described for the following reasons;
• Four patients were not risk assessed;
• Three patients were readmitted into the acute hospital within 24 hours
• One patient died within 24 hours of admission.
21
Bridgewater Community Healthcare NHS Foundation Trust has taken the following actions to
improve this percentage, and so the quality of its services, by ensuring that all patients are
risk assessed and appropriate actions/treatment for all patients within 24 hours of admission
are completed where their length of stay is longer than 24 hours.
Core Indicator
The number and, where available,
rate of patient safety incidents
reported within the trust during
2014/15, and the number and
percentage of such patient safety
incidents that resulted in severe
harm or death
The number and, where
available, rate of patient
safety incidents reported
within the trust during
2014/15
The number and
percentage of such
patient safety incidents
that resulted in severe
harm or death
2014/15
3963 incidents reported
of which 1323 (33%) were
submitted to the NRLS as
2013/14
4655 incidents reported
of which 1088 (23%) were
submitted to the NRLS as
There were 24 incidents
resulting in severe harm
or death, 13 (0.98%) of
which met the criteria for a
patient safety incident
There were 16 incidents
resulting in severe harm
or death, 7 (0.64%) of
which met the criteria for a
patient safety incident
Please see additional information provided in the incident reporting section of this account
regarding the national average, highest and lowest comparative figures from the National
Reporting and Learning Service (NRLS).
The Trust considers that this data is as described for the following reasons, compared to
2013/14: • Incident reporting volumes have decreased by 716 (15%) due to a correction in the
reporting of non-patient safety incidents during 2014/15, please see the Incident
Reporting section for further detail
• The volume of patient safety incidents has increased by 151 (13%) due to closer scrutiny
and more accurate reporting, of these,
• The ratio of No Harm incidents (near miss, insignificant outcomes) increased by
195 (49%) through better recording
• There was an increase of 26 (48%) serious untoward incidents identified
The Trust has maintained or initiated the following actions to improve the collection and
accuracy of this data and indicators, and so the quality of its services, by:
• Increased staff training in root cause analysis documentation and techniques, incident
management and risk assessment
• Routine scrutiny of incidents on a daily and weekly basis by the risk team and senior
clinicians that increases data quality and accuracy
• Increasing the timeliness of risk and incident reported to the Quality Management Group
to discuss and agree service change
• Improving internal incident reports for the re-structured clinical directorates
22
Monitor Compliance / Monitor Risk Assessment Framework
Due to Bridgewater achieving Foundation Trust status on 1st November 2014, the on-going
Trust Development Agency Oversight self-certification and monthly declarations ceased in
September 2014.
Monitor expects NHS Foundation Trusts to establish and effectively implement systems and
processes to ensure that they can meet national standards for access to health care services.
Monitor incorporated performance against a number of these standards in their assessment
of the overall governance of Bridgewater going forward as a Foundation Trust.
Performance against the relevant indicators and performance thresholds is set out on next
page.
23
Access
90%
95%
92%
95%
85%
94%
96%
93%
12
N/A
50%
50%
50%
Maximum time 18 weeks from point of referral to
treatment in aggregate - admitted
treatment in aggregate - non - admitted
treatment in aggregate - patient on an incomplete
pathway
A&E maximum waiting time of four hours from
arrival to admission/transfer/discharge
All cancers: 62 day wait for first treatment from
urgent GP referral for suspected cancer
All cancers: 31 day wait for a second or
subsequent treatment, comprising: Surgery
All cancers: 31 day wait from diagnosis to first
treatment
Cancer: two weeks wait from referral to date
first seen, comprising all urgent referrals
(cancer suspected)
Clostridium (C) difficile - meeting the
C. difficile objective
Certification against compliance regarding access
to health care for people with a learning disability
Data completeness: community services,
comprising: Referral to treatment information
Data completeness: community services,
after comprising Referral information
Data completeness: community services, comprising:
Treatment activity information
2
3
4
5
6
7
8
14
18
19
Threshold or
target YTD
1
Access and Outcomes Metrics 2014/15
(per Risk Assessment framework)
Scoring
1.0
1.0
1.0
1.0
1.0
1.0
1.0
1.0
1.0
1.0
1.0
1.0
1.0
Achieved
Achieved
Achieved
Achieved
Achieved
Achieved
Not Met
Achieved
Achieved
Achieved
Achieved
Achieved
Not
relevant
Current Month
Achieved
/Not Met
99.16%
94.34%
100.00%
Achieved
0.0
100.00%
100.00%
100.00%
100.00%
99.93%
98.20%
98.40%
Apr-14
99.19%
94.40%
100.00%
Achieved
0.0
100.00%
91.00%
100.00%
100.00%
99.89%
97.10%
95.50%
May-14
99.21%
94.96%
100.00%
Achieved
0.0
99.15%
100.00%
100.00%
100.00%
99.71%
99.80%
98.00%
Jun-14
99.24%
95.04%
100.00%
Achieved
0.0
97.16%
100.00%
100.00%
100.00%
99.79%
99.50%
98.70%
Jul-14
99.17%
95.22%
100.00%
Achieved
0.0
99.17%
100.00%
100.00%
100.00%
99.96%
98.60%
99.00%
Aug-14
99.23%
95.53%
100.00%
Achieved
0.0
100.00%
100.00%
100.00%
100.00%
99.91%
98.90%
97.20%
Sep-14
99.24%
95.54%
100.00%
Achieved
0.0
100.00%
100.00%
100.00%
100.00%
99.86%
98.30%
98.20%
Oct-14
*Where the Trust fails any one month during the quarter, the Trust is required to enter the lowest monthly figure (not the average) and the target is failed.
Outcomes
24
99.20%
95.05%
100.00%
Achieved
1.0
100.00%
100.00%
100.00%
100.00%
99.90%
98.40%
95.90%
Nov-14
99.16%
94.89%
100.00%
Achieved
0.0
100.00%
100.00%
100.00%
100.00%
99.32%
94.90%
95.90%
Dec-14
99.23%
95.24%
100.00%
Achieved
1.0
100.00%
100.00%
100.00%
100.00%
99.88%
97.70%
95.40%
Jan-15
99.19%
94.99%
100.00%
Achieved
0.0
100.00%
100.00%
100.00%
100.00%
99.95%
99.10%
93.70%
Feb-15
99.23%
95.41%
100.00%
Achieved
0.0
100.00%
100.00%
100.00%
100.00%
99.83%
99.40%
98.70%
Mar-15
Quality of Services in 2014/15
Trust Quality Measures
During 2014/15 the following Quality Measures were agreed.
The measures were chosen to reflect patient safety, patient experience and clinical
effectiveness, and to demonstrate the quality of care provided by a broad range of our
services.
£
38%
33%
34%
£
80
54
57
£
45%
34%
51%
2
4
2
£
Number of pressure
ulcers which developed
whilst patients were under
our care
Change
2014/15 full 2013/14 full 2012/13 full
compared to
year position year position year position
previous year
£
Indicator to be
measured
0
0
3
Number of serious untoward incidents (SUIs)
Number of reported cases
of Clostridium difficile
Number of reported cases
of MRSA
Ratio of patient falls
(in-patient facilities)
Percentage of patient
facing staff that have been
vaccinated against flu
£
Proportion of incidents
with outcome of “No
Harm “
£
5%
3%
3%
ALW £
Warrington£
Halton &
St Helens£
Dental£
Total£
60%
48%
45%
56%
46%
36%
51%
59%
58%
47%
53%
36%
45%
32%
52%
Comments
V olume of reported
incidents decreased
overall, and the %
ratio of these types of
incidents increased by
comparison
The volume of
reported SUIs
increased by 26 (48%)
with a significant
increase in nonpressure ulcer SUIs i.e.
information governance
breaches and falls
Reported patient
safety incidents
increased by 2%,and
“No Harm” (near miss,
insignificant) outcomes
increased by 11%
NB – the figures
published in last year’s
account included minor
harm
For further
information please see
Clostridium difficile
section
T he overall number
of reported incidents
decreased, and the
ratio of falls increased
by 2%
National average across
all trusts - 54.9%
A vaccination and
immunisation lead post
is to be appointed to
lead the delivery of and
operationally manage
the flu immunisation
programme
25
Indicator to be measured
Change
compared to
previous year
2014/15 full
2013/14 full 2012/13 full
year
year position year position
position
Staff who would
recommend our services to
friends and family
£
3.55
3.48
(reported last
year as 3.47)
3.58
Percentage of patients
indicating they had a good
overall
experience
£
99%
98%
Figure not
collected in
2012/13
Number of complaints
£
91
88
125
Warrington£
97%
95%
97%
ALW £
87%
86%
Halton
81%
Not
available
St Helens
95%
End of life – Percentage
of patients being cared for
in their Preferred Place of
Care (PPC)
26
Comments
T he minimum score is
1 and the
maximum score is 5.
For further
information please see
section on
Statutory Quality
Indicators and
Statements
For further
information please
refer to patient survey
and Friends and
Family Test results
sections of this
account
shton Leigh Wigan
A
data on PPC was not
routinely collated prior
to 13/14.
During 2013/14 Halton
& St Helens jointly
monitored whether
a PPC assessment
had been completed
(93.5%).
During 2014/15 a
standardised approach
has been introduced
to monitoring clinical
standards in end of
life care delivery in
all boroughs. Within
Halton and St Helens
this process has been
introduced from
September 2014 and
we are working
towards embedding
this within teams to
ensure the quality
of the data. During
2015/16 we will begin
to evaluate the data to
highlight areas we can
develop and improve.
Indicator to be measured
Percentage of
immunisations delivered
on schedule for children
reaching their 2nd birthday
Change
compared to
previous year
2014/15 full
2013/14 full 2012/13 full
year
year position year position
position
Please see appendix A
Diphtheria
Tetanus
Whooping cough
polio
Hib
Meningitis C
Pneumococcal
MMR
Percentage of admitted
patients that have been risk
assessed for VTE (Newton
Hospital)
98.75%
99.46%
Figures not
collected in
2012/13
£
Number of patients
re-entering the service
within 30 days (Newton
Hospital only)
£
Comments
7
1
Figures not
collected in
2012/13
Four patients were not
risk assessed;
• three patients
were readmitted
into the acute
hospital within 24
hours
• one patient died
within 24 hours
of admission.
Of the 7 patients
readmitted within
28 days to Newton
1 patient had a fall,
2 had a decline in
medical condition, 1
not coping at home
and 3 patients mobility
deteriorated further
following discharge.
They were readmitted
back into Newton
Community Hospital
which avoided
admission into an
acute hospital bed
27
Patient Experience
The Trust recognises that eliciting, measuring and acting upon patient feedback is a key
driver of quality and service improvement. The Trust has a Patient Charter outlining what
people should expect from Bridgewater services and who to contact if they do not meet
those standards. The Trust uses a range of methods to seek patient feedback including the
use of patient stories, patient surveys, which include the Friends and Family question and
the use of Patient Partners, as a way of involving the people who actually use the services.
All feedback is closely monitored with any lessons learned identified and cascaded across
the organisation.
Patient Story
A patient story is presented to the Board each month. This is a compelling way of illustrating
the patient’s experience and enables the Board to gain a meaningful understanding of how
people feel about using our services.
Lessons learned from each story are identified and action plans are developed and
monitored monthly to ensure that quality and service experience issues are acted on and
lessons learned across the whole Trust.
Some examples of patient stories during the year include:
• Adult Continence Service
How the service supported a patient to use a range of products and equipment which
fitted-in with their life style and has given them confidence when on holidays abroad, using
trains, and going to the theatre.
• Adult Learning Disability Service
How the service supported a patient living alone with a history of diabetes, no social care
provision and who had not attended for a check-up at his GP surgery for over 3 years. Patient
was unable to read letters from healthcare providers and therefore was not able to access
appropriate services. The service supported him to identify and understand his needs and
ensured information was accessible in easy read/pictorial letters.
• Health Visiting Service
How a mother was involved in the service as a Parent Partner to share her experience of the
service in order to ensure the service was continually improving and meeting the needs of
patients.
• Augmentative and Alternative Communication Network
A remarkable story about a patient with cerebral palsy, who helped develop a communication
tool to enable them to communicate.
The patient uses Alternative and Augmentative Communication (A.A.C.) and would like to be
a role model for new users and anxious parents.
28
Patient Survey and Friends and Family Test Result
Bridgewater has developed a ‘Talk to Us…’ form to seek patient feedback. This includes the
Friends and Family Test (FFT), which became mandatory for all Community Trusts from
January 2015, as well as a number of questions which aim to ascertain how people feel
about accessing Bridgewater services.
The FFT is based on a simple question “How likely are you to recommend our service to
friends and family if they needed similar care or treatment?” with answers on a scale of
extremely likely to extremely unlikely.
Although the FFT only became mandatory for all Trusts from January 2015, this has been
implemented across Bridgewater since 2013 and during the year, a total of 22,613 people
responded to the FFT question. The way the FFT is reported has changed during the year
and the results are now shown as a percentage of people who would recommend the service
and those who would not. The results from October 2014, when the new system of analysing
the results was introduced, are shown below.
Borough/Service
Dental Services
Halton
St Helens
Warrington
Wigan
Number of
Responses
493
1526
1371
819
1997
Quarter 3
Would
Recommend
99%
97%
97%
98%
96%
Would NOT
Recommend
1.1%
0.5%
1%
0.5%
0.4%
Number of
Responses
454
1226
2482
1342
3506
Quarter 4
Would
Recommend
99%
98%
96%
98%
96%
Would NOT
Recommend
0.5%
0.6%
0.3%
0.3%
0.8%
The survey results from the follow up questions show that 24,820 people have responded to
the questionnaires since April 2014 and 99% have expressed overall satisfaction with their
care and treatment.
Patient Partners
Patient Partners is a Bridgewater initiative to showcase how to actively involve patients and
carers to work with staff to identify areas for improvement in quality of care and service
delivery.
Over 190 Patient Partners are actively involved in working with the services to identify and
implement service improvements. The services working with Patient Partners include:
• Adult Speech and Language Therapy (Halton).
• Changes include the development of a ‘Loud treatment group’ to be set up to
support intensive, evidence based therapy for speech difficulties for people with
Parkinson’s Disease.
• Dermatology (Wigan)
• Eczema Expert - Patient Partners within focus groups supported the development
of a Top Tips sheet for emollient and steroid use within the Eczema Expert pack
and continue to provide feedback to support development.
29
• Heart Failure Nurse Specialist Healthy Heart Service (Halton and St Helens)
• Capturing patient stories on their journey through the service, including ease of
access to the service, the quality of the information provided and what we could
do to improve the service.
• School Health (Warrington)
• Capturing the views of children and young people who have asthma, about their
experiences and how the services could help them understand and manage their
condition.
Patient Advice and Liaison Service
We recognise that when people have issues or concerns with our services we should aim to
resolve these as quickly as possible. Bridgewater provides a single free phone number for
people to contact for advice and information or to help resolve their issues and
concerns.
During 2014/15 we received 1440 contacts across Bridgewater, as summarised below.
Corporate
Dental
Halton
St Helens
Warrington
Wigan
Willaston
Total
Quarter 1
2
11
48
50
94
151
0
356
Quarter 2
0
12
64
46
95
164
1
382
Quarter 3
3
8
48
45
95
122
0
321
Quarter 4
4
14
56
50
101
153
3
381
Total
9
45
216
191
385
590
4
1440
Around 51% of the contacts were requests for advice and information, including signposting
to other organisations.
Almost 49% of the contacts resulted in the department liaising between the enquirer and the
service to resolve issues and concerns. Examples of the issues raised include appointment
delay/cancellation and staff attitudes.
Only 8 of the 1440 contacts went on to become formal complaints.
30
Complaints
We aim to learn from complaints as part of improving our patients’ experience.
During 2014/15 we received 91 complaints compared to 88 during the previous year. These
are summarised on a Borough/Service basis below:
Number of
Complaints
Dental
Halton
St Helens
Warrington
Wigan
Willaston
Total
5
19
18
21
25
3
91
The complaints were divided across a range of issues. The themes are summarised in the
table below:
Theme of complaint
Number
Aspects of clinical treatment
62
Attitude of staff
13
Aids and appliances, equipment, premises
5
Appointments, delay/cancellation (outpatient)
4
Failure to follow agreed procedures
4
Admissions, discharge and transfer arrangements
2
Patients’ privacy and dignity
1
Total
91
Every complaint received is investigated to understand fully what has happened and to seek
out the lessons that can be learned. All lessons learned are discussed with the service leads
at the lessons learned group and cascaded via Team Brief.
Some examples of lessons learned include:
•
•
Ear Care Service – All ear care patients to be provided with written information
outlining potential side effects. This will be recorded on SystmOne when the
information leaflet has been posted with appointment.
Walk-in Centre (WIC) – a concern was raised as to whether it is normal policy to
refuse treatment based on the fact the night had been busy, the conduct of the nurse
who saw the child and the notes that were put on her clinical records.
• Closing procedure for WIC to be reviewed to ensure it supports the decision
making process for patients attending at the end of the day.
• Customer Care training initiated for all patient facing staff.
• Dental Services – Following a complaint about staff attitude and the lack of care and
treatment received from a particular dentist in one of our community dental services.
• E-learning package purchased from the National Autistic Society to enable dental
staff to understand the effects of autism in dental health and treatment.
• The package will be shared with the Learning and Development Team to be
accessible to all services.
31
Staff Engagement, Health & Wellbeing
Our key priorities for 2014/15 were to:
•
•
•
•
•
•
Improve on the national NHS Staff Survey results
Improve the national NHS Staff Survey ‘Engagement‘ score
Improve the national NHS Staff Survey score for Staff recommending the Trust as a place to work and receive treatment
Increase the Personal Development Review rate (Staff appraisal)
Reduce sickness absence rates against a Trust target of 3.78%
Achieve Trust target of a rolling 8% for staff turnover.
Staff Engagement
The Trust promotes effective employee engagement to create a motivated and valued
workforce which ultimately leads to better patient care and service experience. Engagement,
consultation and ensuring effective communications with our staff is of paramount
importance. During the past 12 months we have continued to improved our methods of
communication, involvement and engagement with staff to enable them to understand the
aims and objectives of the Trust, its mission, vision and values.
The key performance indicators have helped the Trust to measure, and will continue to help
measure the quality of staff experience. Data relating to workforce indicators are reported to
the Trust Board as are the annual national NHS staff survey results.
We enjoy effective partnership working with our Trade Unions and Staff-side colleagues and
believe this is critical to our success.
We have various information and communication channels, engagement systems,
programmes and initiatives which include, but are not limited to:
• A monthly Team Brief cascade led by the Chief Executive and Executive Team. The
Brief is cascaded by managers across the whole organisation within seven days
• A weekly Trust Bulletin which provides staff with information as to what is happening
within the Trust, patient stories, the events that they can attend, seminars, workshops
and forums they can engage in. Staff are able to contribute to the content of the
Bulletin, put questions to the Trust’s communications team and partake in research
programmes and promote the good work of their services as per its regular ‘Spotlight
on Services’ feature
• A “Star of the Month Award” whereby staff can nominate colleagues who have gone
over and above their role, living up to the Trust’s values and demonstrating ‘star’
qualities. Awards are presented by the Chief Executive and publicised in the
Bridgewater Bulletin, Trust Intranet and website
• Trust wide Staff Awards were held in March 2015. There were six Awards categories:
• Clinical Employee of the Year
• Non-Clinical Employee of the Year
• Team of the Year
• Outstanding Contribution to Innovation
• Patient Choice Award – nominated by our Patients/Members
• Chairman’s Award for Lifetime Achievement
32
• The Chief Executive’s Blog is featured in the Trust Bulletin and also accessible to staff
via the Trust’s Intranet
• The Trust Intranet keeps staff updated with current information on the organisation;
what is happening within the Trust, its services, organisational change, developments,
initiatives, innovation and improvements
• Director Walk-abouts enable staff to meet members the executive team to discuss the
quality of services they delivery and listen to their views, ideas and what it is like to
work for the Trust
• Professional Forums, which are made up of clinical staff, include presentations and
workshops on national, regional and local issues and initiatives, best practice and
networking opportunities
• The Productive Community Services Programme enables staff to share their
experiences of service improvements and developments. Staff have and are adjusting
to new ways of working. Staff who have undergone modules have reported much
improved working environments, increased face-to-face contact time with patients
and less time spent on administration tasks due to system and process
improvements, enabling more time to deliver patient care.
NHS Staff Survey 2014
Working with staff to understand key messages from the staff survey
The Trust takes part in the national annual NHS staff survey. As well as providing us with
feedback on how we are doing and how staff are feeling in relation to 29 ‘Key Findings’, we
are provided with a national ‘staff engagement’ score. Our 2014 score slightly improved in
comparison to 2013 from 3.61 to 3.67. The scoring system is a scale of 1 to 5 with 1 being
‘strongly disagree’ and 5 ‘strongly agree’.
The overall indicator of staff engagement is calculated using the following ‘Key Findings’
questions:
• KF22: Staff ability to contribute towards improvement in work
• KF24: Staff recommendation of the Trust as a place to work or receive treatment
• KF25: Staff motivation at work
To ensure that we continue to listen to our staff and acknowledge the important feedback we
get from our survey, we develop action plans to inform us of our key priorities and areas for
further developments and continuous improvements. The action plan is and will continue to
be managed through formal management meetings where performance reviews take place.
Action plans and progress against the same are shared with our Staff-side colleagues at our
partnership working groups.
As part of our response to the staff survey to enable staff to see how we are responding to
their feedback, we have developed the “Listening to You” approach…”You said, we did…
are doing” cascades. Year on year we ensure that we measure the changes identified in the
staff survey as it provides a structured, evidence based way for us to engage with staff and
respond to their feedback. We have also introduced ‘Chris’ Clinic’ which gives direct access
to the Trust’s Director of People, Planning and Development on a weekly basis, enabling an
opportunity for staff to ask questions or raise issues on an individual basis.
33
We have a quarterly staff friends and family test which is focussed on areas of the national
staff survey, enabling us to monitor our progress throughout the year.
The staff survey results provide us with our top five and bottom five ranking scores:
Top 5 Ranking Scores - The five areas for which the Trust compares most favourably with
other Community Trusts in England are:
• KF17: Percentage of staff experiencing physical violence from staff in last 12 months
• KF27: Percentage of staff believing the trust provides equal opportunities for career
progression or promotion
• KF19: Percentage of staff experiencing harassment, bullying or abuse from staff in last
12 months
• KF16: Percentage of staff experiencing physical violence from patients, relatives or the
public in the last 12 months
• KF12: Percentage of staff witnessing potentially harmful errors, near misses or
incidents in last month.
Bottom 5 Ranking Scores - The five areas for which the Trust compares least favourably with
other Community Trusts in England are:
• KF2: Percentage of staff agreeing that their role makes a difference to patients
• KF29: Percentage of staff agreeing that feedback from patients / service users is used
to make informed decisions in their directorate / department
• KF8: Percentage of staff having well-structured appraisals in last 12 months
• KF21: Percentage of staff reporting good communication between senior
management and staff
• KF15: Percentage of staff agreeing that they would feel secure raising concerns about
unsafe clinical practice
Although we saw a deterioration in 11 of our ‘Key Findings’ in comparison to the 2013 with
the exception of KF7: Percentage of staff appraised in the last 12 months, staff survey
results were not statistically significant. There has also been an improvement in scores on
16 of the Key Findings from 2013 to 2014. None of the scores in which there has been an
improvement are statistically significant. This was welcoming for the Trust in light of the major
organisational changes affecting staff. Improving on the staff survey results will remain a key
priority through our action plans and focus groups.
Staff Health & Wellbeing
We continue in our commitment to reduce sickness absence through effective management
and support from Occupational Health and the Trust’s Human Resources team. A healthy
motivated workforce is integral to achieving better care for our patients. We have an
occupational health service which provides staff with:
• Telephone and face to face counselling services
• Physiotherapy services
• Occupational health referral and assessment services, including speedy referrals for
mental health and muscular-skeletal disorders.
34
Our Occupational Health Service provides us with information that helps us identify areas of
staff health and wellbeing that may require more attention, such as issues of personal and
workplace stress. The introduction of online occupational health referrals has enabled more
timely referrals and feedback on medical assessments / opinions.
The Trust recognises that any adverse impact on staff that affects their ability to function at
their best in the workplace needs active steps to provide support and take a preventative
stance where possible. The Trust will be recruiting a member of staff to support the
managing and handling of staff health and wellbeing.
The Trust’s sickness absence target is 3.78%. The absence rate at the end of March 2015
was 5.68% in comparison to 4.90% at the end of March 2014.
Management are provided with monthly absence reports which enable them to monitor
absence in line with the Trust’s policies and procedures. Absence rates are monitored
monthly by the Trust Board.
Personal Development Reviews (PDRs)
We continue to provide opportunities for our staff to develop via a ‘values’ driven personal
development review to ensure they can continue to meet the needs of our aims, objectives
and patients.
The Trust’s focus on PDRs has been captured within the 2014 NHS Staff Survey in which 85%
of respondents confirmed that they had been appraised in the last 12 months. This is the
survey’s ‘Key Findings’ for which the Trust has had a significant reduction since 2013 when
94% of staff confirmed they had been appraised.
Directorate
Percentage of Staff Compliance
Adult Services
96.99%
Children’s Services
91.32%
Corporate Service
49.66%
Specialist Services
96.71%
BRIDGEWATER
91.15%
Concerted efforts will be focused into ensuring that staff have an annual PDR. Managers
now complete and return monthly compliance reports which enable senior managers to
review PDR take up, compliance and non-compliance by way of individual staff members
within their Teams. To ensure PDRs are meaningful, we will be focussing on improving our
bottom five ranking staff survey scores.
Staff Turnover
The rolling staff turnover for the Trust as at 31 March 2015 was 14.07%. This is above the
Trust target of 8% however during a time of organisational change and continuing cost
improvement programmes this is not necessarily unexpected or a cause for concern. Work
is on-going around staff engagement and any particular issues should be identified during
this stream of work.
35
Responsible Officer Compliance
The introduction of Medical Revalidation in December 2012 has reinforced the
interdependent responsibilities of healthcare organisations and individual professionals
around patient safety and good medical practice. Medical revalidation has placed new
statutory duties on organisations and individuals, to ensure that doctors are practising in well
structured, managed and governed systems.
Through utilising PREM IT electronic appraisal system, Bridgewater is supporting the
evaluation of our doctors’ fitness to practise in a fair and consistent way. Currently we are
100% compliant with our appraisals returns. The next step is to establish a reporting process
that will not only evidence our compliance, but also provide assurance at Board Level that
our medical professionals are operating safely and providing good medical care.
Education & Professional Development
The primary aim of the Education and Professional Development (EPD) Service is to support
all health care staff within Bridgewater to have up to date, evidence based knowledge, skills
and abilities in order to ensure that they can provide safe, effective and compassionate care.
Mandatory Training
During 2014/15 substantial work has been undertaken to review the mandatory training and
induction programmes. This has involved consideration of a new eLearning platform and
alignment to national and local agendas.
Continuing Professional Development
Continuing Professional Development (CPD) is fundamental to the advancement of all staff
and is the mechanism through which high quality care is identified and maintained (DH
2014). The EPD service has continued to support all staff to further develop their knowledge,
skills, practical experience and competencies. This is achieved by completion of an annual
Training Needs Analysis which is based on both individual learning and development needs,
identified through Personal Development Review, and the Commissioned Service delivery.
This ensures that staff have the right skills to deliver a high quality service to meet the
identified needs of the population they serve. In 2014/15 training has been provided on a
variety of topics including:
• Clinical skills
• Coaching and Mentoring
• Communication and Difficult Conversations
• Leadership and Management
• Record Keeping
In addition, we continue to support and fund staff to attend external learning and
development opportunities and to access academic modules on a wide range of subjects for
example:
36
• Advanced Clinical Skills
• Apprenticeship frameworks, vocational qualifications and cadet programmes
• Public Health
• Prevention and Early Intervention
•Research
Educational Governance and internal Quality Assurance processes are in place and aligned
to the Education Outcomes Framework (DH 2013). This guarantees continual improvement
of the training provided and that it matches the expectations of the public, staff, employers,
healthcare professional bodies and, if appropriate, statutory requirements.
Competence Frameworks
A Competence Development Group was established in early 2014 to support the
development of competence frameworks for all grades of patient facing staff. These are
currently being piloted within several of our services and will be evaluated prior to Trust wide
implementation. This will support continuous assessment and on-going development of staff
and provide assurance on the skills, competence, attitudes and behaviours of our staff.
The Trust has also taken an active role as a member of the North West Steering Group in the
development and testing of the Care Certificate Framework; in response to the
recommendations of the 2013 Cavendish Report. The Care Certificate covers 15 standards
that set out the learning outcomes, competences and standards of behaviour expected of
all healthcare support workers to ensure that they are caring, compassionate and provide
quality care. As a result of the feedback received from the Trusts involved in the development
and testing, the Care Certificate was formally launched in April 2015 and is currently being
implemented by all health and social care organisations in England.
Pre-Registration
The development of future healthcare professionals is at the very heart of our education and
professional development offer. A dedicated team of practice education facilitators work in
partnership with our clinical staff and services and with our partner universities to ensure the
maintenance of high quality educational placements and positive learning experiences. The
team also supports practice education through the on-going development and maintenance
of our qualified mentors and educators. The Trust is able to offer students the opportunity
to undertake placements in a diverse range of clinical services and in integrated health and
social care settings. This prepares our future practitioners to respond to the needs of our
current and future population as health and social care continues to transform and develop.
Forward Planning
In 2015/16, we will continue to develop the Professional Development Support Framework to
underpin education provision with a particular focus on revalidation to include accountability,
clinical supervision and action learning sets. In addition, we plan to further affirm our
commitment to the development of our future workforce through wider access to work
experience programmes and through the development of placements to support
undergraduate medical students.
37
Leadership Programme and the Bridgewater Quality Improvement Programme
Bridgewater’s Quality Improvement Programme has been established to support the culture
of continual improvement within the Trust. Bridgewater has worked in close collaboration with
the Advancing Quality Alliance (AQuA) to research, design and deliver a bespoke
improvement course. Course participants focus on improving clinical outcomes for our
patients through increasing capability and flexibility within the workforce.
The first cohort of band 6-8 staff commenced in January 2014, the second programme
commenced in September 2014 and the third programme is due to commence in May 2015.
The style of learning is interactive and uses the knowledge and expertise of the course
participants throughout the three modules, which cover an introduction to quality
improvement and quality improvement tools, an introduction to Lean and the human
dimensions of change.
The tools and techniques used throughout include the latest principles from both industry
and healthcare.
The modules are designed to equip participants with transferable knowledge and to be able
to share their learning within the workplace.
The course requires completion of a work based project and examples of the projects are
included below:
• How we best utilise the skills of therapy assistants (redesign of role to increase
capacity and skill mix capability in the team).
• Speech and Language Therapy – social marketing – understand the needs of local
schools and what will improve our relationships.
• FallSafe programme with ward staff to reduce incidence of inappropriate falls for bed
based services.
• Review inappropriate referrals with integrated community discharge planning team,
collaboration between community and acute trust.
• Review and redesign role of health care assistant to become more involved in the
care of patients at the Walk in Centres.
Library Strategy
Bridgewater Library and Knowledge Service (LKS) has continued to develop in line with its
strategic plans for 2012-15. As a result we scored 87% in the 2014-15 annual quality
assurance process (LQAF), which measures NHS libraries’ performance nationally. This is a
further improvement on previous scores and brings us in line with other Trusts in the
Northwest.
In February 2015, a new national strategy for NHS Library and Knowledge Services was
published. Entitled “Knowledge for Healthcare: a framework for NHS library and knowledge
services in England 2015 – 2020”, the national strategy sets out the strategic intentions for all
38
NHS library services up to 2020. The Bridgewater LKS response has been to revise and
update our local strategy in line with national expectations. The Bridgewater strategy for
2015-18 focusses on the consolidation of achievements to-date and ensures that LKS
services are equally available to Bridgewater staff irrespective of their location. As a
community trust with a wide geographic spread, we rely heavily on information technology to
deliver evidence in electronic form. In 2014-15, Bridgewater staff and students logged in to
databases 1571 times using OpenAthens authentication. This is an increase from 785
accesses in 2013-14.
The reduction of health inequalities is a fundamental part of the framework within which all
NHS organisations operate. The Health and Social Care Act 2012, the NHS Constitution, the
NHS Outcomes Framework and the Five Year Forward View all set out the commitment to
reduce health inequalities and improve healthy life expectancy. The first two CQC
Fundamental Standards, (Person Centred Care and Dignity and Respect), also reiterate the
commitment nationally to provide a healthcare service that is equitable in access and
outcomes for all members of our society. These national strategies, the Equality Act 2010 and
the Human Rights Act 1998 provide the legal framework within which the Trust operates its
equality governance.
In order to demonstrate compliance with the Equality Act the Trust uses the national NHS
Equality Delivery System (EDS2) to assess and grade performance on 18 outcomes across
four goals – two patient centred and two staff and management centred. Using the
information gathered in the completion of the annual Public Sector Equality Duty report, the
EDS2 process and the equality analysis of services the Trust determines actions for the
coming year(s).
At Board level, responsibility for equality diversity and inclusion sits with the Director of
People, Planning and Development. The Head of Health Inequalities and Inclusion ensures
that the Trust is meeting its legal responsibilities and provides strategic direction in relation to
equality and health inclusion. The Equality and Human Rights Project Officer works with
services to provide guidance and support on equality and diversity issues. The Trust’s
Equality Statement sets out the commitment to equality and inclusion and is supported by
an Equality and Health Inequalities Action Plan. Board assurance on the fulfilment of equality
goals and objectives is provided by the Quality and Safety Committee who review the actions
of the Health Inequalities and Inclusion Team and report on a six monthly basis. In addition,
regular updates are provided to the Trust’s commissioners by the team.
The Trust has a network of over 100 personal fair diverse champions who receive regular
updates to cascade to their staff; updates in the last year have included child sexual
exploitation, autism friendly Christmas and stroke awareness.
As a health care provider the Trust requires all services to have a completed an equality
analysis.
The Health Inequalities and Inclusion Team plans for 2015/16 include the signing of British
Deaf Association BSL Charter, the production of reasonable adjustments guidance for Trust
staff, the production of religion and belief guidance for staff, the start of a rolling programme
of access audits of Trust services, a review of language interpretation and translation
39
provision, further awareness raising through the personal fair diverse Trust champions and
submission to Stonewall Workplace Equality Index. In addition the Trust will be reporting on
the key indicators in the new NHS Workforce Race Equality Standard.
Detailed Trust equality information such as our Public Sector Equality Duty reports, our EDS
(and EDS2) grading results and service equality analysis are published on our website
http://www.bridgewater.nhs.uk
Delivering Same Sex Accommodation (DSSA) (Halton,
St Helens and Warrington Boroughs)
Newton Hospital
Every patient has the right to receive high quality care that is safe, effective and respects their
privacy and dignity. Newton Community Hospital (our only inpatient facility) is committed to
providing every patient with same sex accommodation as it helps to safeguard their privacy
and dignity when they are often at their most vulnerable. Other than in exceptional
circumstances, patients admitted to Newton Community Hospital can expect to find the
following standards for the provision of same sex accommodation:
• the room where their bed is will only have patients of the same sex
• the toilet and bathroom will be just for one gender and will be close to the bed area
• patients may share some communal space, such as day rooms or dining rooms
Occasionally, it may not be possible to care for patients in a same sex environment, e.g. in
the case of an emergency or specialist care situation. The clinical (medical) need will take
priority over keeping the patient apart from other patients of the opposite sex.
We can confirm for the period of April 2014 until March 2015 there were no breaches to the
same sex accommodation.
Padgate House
Padgate House is a 35 bedded intermediate care unit based in Warrington. The building is
owned and managed by Warrington Borough Council. The Trust is responsible for the
provision of clinical services. The home has 35 single bedded rooms which are not en-suite.
This ensures that patients never share a bedded area. The building has 14 bathrooms which
are shared by all residents meaning that males and females will share the same facilities
however there are clear engaged signs on doors and doors are lockable from the inside to
maintain patient privacy. Staff are able to unlock doors from the outside should the need
arise to ensure patient safety and were necessary staff will accompany and assist patients
whilst using bathrooms. As Padgate House is not a hospital they are not considered to
breach under the mixed sex accommodation requirements for use of communal bathroom
facilities.
Incident Reporting
The Trust utilised the web-based Ulysses Safeguard Risk Management System for reporting
all actual incidents and near misses, where clinical service delivery or patient safety may
have been compromised.
40
There was a decrease in 2014/15 reporting compared to 2013/14 due to more accurate
reporting and changes in service structures during 2014/15. Increasing accuracy of
incident reporting is a positive indication of an open and honest culture that encourages staff
to report incidents.
1400
2013/14
2014/15
1278
1200
1131
1013
1000
1143
1041
1127
993
916
800
600
400
200
0
Quarter 1
Commissioning Borough
ALW
Quarter 3
Quarter 2
Quarter 4
2013/14
2014/15
1304
1173
-131
8
+8
Cheshire*
Variance
-10%
Halton
829
766
-63
-8%
St Helens
1234
1031
-203
-16%
Trafford
30
1
-29
-97%
Warrington
930
761
-169
-18%
Prisons (NHS England)
85
80
-5
-6%
Dental (NHS England)
233
134
-99
-42%
Corporate
34
9
-25
-74%
4679
3963
-716
-15%
Total
*Cheshire Commissioners came online with the introduction of the Willaston Primary Care
Service in July 2014.
Due to weekly and monthly incident data reviews by senior clinicians and managers,
introduced during 2013/14 and maintained during 2014/15, the quality and accuracy of data
has continued to improve during 2014/15. Along with daily checks undertaken by members
of the risk team, this process also ensures that any serious incidents are identified early and
escalated as quickly as possible for management attention.
The ‘Care Indicator Tool for Pressure Ulcers’ demonstrated quarterly improvements in
pressure ulcer management by clinicians and continues to be utilised during 2014/15 to the
benefit of patient outcomes. The added value of this data resulted in improved investigations
and identified gaps for service change, notably, the frequency of review of patient’s pressure
ulcers.
41
There were 13 (0.98%) patient safety incidents reported that resulted in major or catastrophic
outcomes. Staff reported 3963 incidents during 2014/15, 1323 (33%) of which were
categorised as incidents or near misses effecting patient safety. These are submitted to the
National Reporting and Learning Service (NRLS), from which the CQC nationally monitors all
Trusts’ patient safety incidents. The following table represents the number of patient safety
incidents reported to the NRLS by level of actual impact.
Patient Safety Incidents by
Actual Impact
2013/14**
2014/15
2014/15
Near Miss
114
10%
203
15%
+89
+6%
Insignificant
285
24%
391
30%
+106
+5%
Minor
636
54%
546
41%
-90
-13%
Moderate
128
11%
170
13%
+42
+2%
Major
5
0.43%
4
0.30%
-1
-0.12%
Catastrophic
4
0.34%
9
0.68%
+5
+0.34%
1172
1323
+151
**Compared to the 2013/14 Quality Account, the incident data has increased due to
retrospective data input and update after data was extracted for that report
Patient Safety Incidents by Actual Levels of impact
Minor, 609, 56.0%
Moderate, 114, 10.5%
Catastropic, 3, 0.3%
Other, 7, 0.6%
Near Miss (no harm), 97, 8.9%
Major, 4, 0.4%
Insignificant, (no harm) 261, 24.0%
Although the overall volume of reported incidents (3963) has decreased compared to last
year by 716 (15%), the volume of patient safety incidents (1323) increased by 151 (13%)
compared to 2013/14. An increasing volume of reported patient safety incidents and more
serious incidents offers assurance that staff continue to honestly and openly report issues
relevant to the safety of patients and where increased actual harm has occurred. The ratio
of ‘No Harm’ patient safety incidents increased by 195 (49%); near misses and insignificant
outcomes each increased by 89 (6%) and 106 (5%) respectively compared to 2013/14.
42
14/15 Qtr 4
14/15 Qtr 4
14/15 Qtr 3
14/15 Qtr 2
14/15 Qtr 1
13/14 Qtr 4
13/14 Qtr 3
13/14 Qtr 2
0
13/14 Qtr 1
200
14/15 Qtr 3
400
14/15 Qtr 2
600
14/15 Qtr 1
800
13/14 Qtr 4
1000
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0
13/14 Qtr 3
1400
1200
13/14 Qtr 2
Non-PSI
PSI
13/14 Qtr 1
Non-PSI
PSI
The Children and Family Services Directorate confirmed that, compared to 2013/14, the
reduction in reported incidents confirms a correction in reporting more accurately rather than
any reporting downturn.
Similarly, in the previous division-based structure, services in the ALW division reported high
numbers of demand and capacity concerns via the incident reporting system rather than
incidents that directly impacted on service delivery or patient care. The managers have now
documented these issues on the Operational Risk Register and are monitoring these directly
with clinical managers. A number of actions have been put in place to address these
concerns:
• Procurement of capacity planning tool in ALW Health Visiting and School Nursing
services with the involvement of staff
• Involvement of teams in service planning via the clinical reference groups
• Profession-specific leadership as a result of the ALW operational management and
team restructure
• Improved timescales for completion of vacancy control forms so staff can see the
recruitment process progressing
• Team leader and professional meetings set up to improve communication and aid
solution focused thinking
All incidents were routinely investigated and, in some cases, these may have been escalated
into a full root cause analysis based on a consistent national methodology. The Trust
maintained a pool of over 40 staff (clinical and non-clinical) specifically trained in root cause
analysis techniques thus ensuring that incidents are thoroughly investigated and lessons are
learned to prevent recurrence.
43
Patient Safety Incidents reported to the National
Reporting and Learning Service (NRLS) April
2014 to September 2014 by NRLS Degree of
Harm
Ave from similar
organisations*
Reported from similar
organisations
Total
%
N
%
Lowest
Highest
None
327
45%
929
52%
230
1492
Low
296
27%
618
34%
94
1585
Moderate
96
41%
227
13%
87
537
Severe
3
0.41%
15
0.82%
0
89
Death
7
0.96%
3
0.19%
0
15
729
1792
* National figures obtained from the NRLS April 2015 report. Please note that:
• The averages include Bridgewater data,
• This national data covers patient safety incidents reported from April 14 to September
2014 (October 14 to March 2015 data is available later in 2015), however,
• The NRLS advises that not all organisations apply the national coding of Degree of
Harm in a consistent way, which can make comparison of harm profiles of
organisations difficult, also
• Most other providers are not solely Community Trusts as Bridgewater is i.e. they have
some mental health or acute functions; as a result, of the 19 Trusts that the NRLS has
compared Bridgewater to, there is only one other Community Trust with a service
profile similar to Bridgewater and against which the Trust remains comparable
The following initiatives were undertaken during 2014/15 to improve our management of
incidents:
• Automated weekly incident reports to senior managers every Monday morning of the
previous seven days incident details to identify any concerns
• An increased pool of trained root cause analysis investigators during the final quarter
• Automatic notification of all pressure ulcers to all the tissue viability nurses
immediately on submission
• Improving rates of pressure ulcer photographs attached electronically to incidents in
order that the tissue viability nurses can provide early advice remotely.
Never Events
Never events are serious, largely preventable patient safety incidents that may result in death
or permanent harm, that should not occur if the available preventative measures have been
implemented. The Department of Health reviews a list of these each year and there are 25
different events that all Trusts continually monitor. If they occur, we are required to report
directly to the Care Quality Commission and our commissioners. There were no such events
occurring during 2014/15.
44
Central Alert System
Using incident data from across England, the NHS develops national initiatives and training
programmes to reduce incidents and encourage safer practice. Alerts are released through
a single “Central Alerting System” (CAS) to NHS organisations which are then required to
indicate their compliance with these safe practice alerts. They cover urgent regional or
national matters concerning faulty medical devices, medication, estates issues and other
patient safety issues. The Trust received 101 clinical alerts, and 59 non-clinical alerts, which
were then cascaded to each directorate and onto service leads to assess the action required
for each alert. All alerts relevant to patient safety in the community sector were assessed
within the required timescales and action plans for improvement put in place where they were
applicable to community healthcare.
At the end of 2014/15 the Trust was assessing the relevance of three alerts to meet any
recommendations within the expected completion dates set later in 2015/16.
Pressure Ulcers
Pressure ulcers can range from redness of the skin, to a small graze to a cavity. All patients
with pressure ulcers are regularly reviewed to identify where, how and why they developed.
In particular any pressure ulcer that develops or deteriorates whilst in our care has to be
investigated to identify the cause and any areas where we could have improved our care.
More serious pressure ulcers are reported to the GP, commissioners and the NHS Area
Teams. The Trust is then monitored to ensure that we have identified the reasons for the
development of pressure ulcers and any actions we need to undertake to improve future
care.
A system for reporting all pressure ulcers is in place. During 2014/15 a total of 1153 pressure
ulcer incidents were reported by staff of which 716 (62%) developed before our involvement
in their care, 437 (38%) developed or deteriorated whilst the patient was under the care of
the Trust. The Trust actively encourages all reported incidents and near misses are shared
with patients and their relatives/carers. However, where an incident carries an impact score
of 3 (moderate) or above sharing this information is now compulsory and this Trust monitors
adherence to this through its Quality Management Group.
Many patients who develop or experience a deterioration to an existing pressure ulcer may
have infrequent visits from district nursing, for example four times a year. Therefore, it is
important that we work closely with patients and their carers to support them to care for their
pressure areas. We have developed a patient information leaflet on what good pressure
relief looks like, demonstrating pressure relieving techniques and provision of pressure
relieving equipment where appropriate. District nurses actively encourage and rely on
feedback from patients and their carers regarding any changes to the patient’s condition that
requires a district nurse to check.
A training programme is delivered by our tissue viability team to all staff. This includes both
taught sessions and workbooks for staff to complete. Within each team there are dedicated
link nurses, who are registered nurses with additional training. Link nurses are then
responsible for supporting staff to complete their competence in pressure ulcer care. Link
nurses then act as a point of contact for any further guidance needed in relation to specific
patients working closely with the tissue viability nurse’s when required.
45
The Trust also has a pressure ulcer working group which monitors the pressure ulcer action
plan, which was developed to ensure all the right organisational systems and processes were
in place to support staff who were caring for patients with pressure ulcers or who were at risk
of developing them. The information leaflet and training programme came out of this work.
Building on this work from last year we have now implemented a process to monitor our
performance against the new processes and national standards. Achievement against
the standards can be evaluated at team, neighbourhood or borough level and is reported
quarterly to our Quality Management Group. In the event the standard has not been fully
achieved, an individual or team performance plan is developed to guide the necessary
improvements.
Workforce Planning – Staff in the right place at the right time
with the right skills
Through the delivery of the Trust’s service transformation and cost improvement
programmes, we have become much better at understanding what patients and the public
want and need. It is important that we have a workforce that is flexible, mobile and is being
continually developed around patient need.
Managers undertake workforce planning in line with an agreed model.
From April 2014, we have been required nationally to publish our staffing levels set within the
guidance and context of ‘Safer Staffing Levels’. As a Community Trust we only have to report
Safe Staffing for our Community Hospital inpatient unit. This information has been submitted
monthly and in 2014/15 the Board have received monthly reports. The information is also
shared on NHS Choices and our web site.
http://www.bridgewater.nhs.uk/saferstaffing/
Coroner’s Cases
The Trust received a Regulation 28 ‘prevention of future deaths’ report in December 2014
following the inquest into the death of an infant in April 2014. The death occurred the
morning after he had been seen and examined by the GP Out of Hours Service in Warrington.
The coroner raised four matters of concern with the Trust and stated that ‘there is a very clear
training need identified here in relation to the appreciation of this type of occurrence with very
young children’.
The Trust has addressed the concerns raised in the report and has responded to the
Coroner and the patient’s family in a timely manner. The Chief Executive met with the
Coroner to investigate how we as a trust can assist the Coroner’s Office with processes to
ensure we are always able to represent our view and to assure both him and the family of the
actions we have taken within the Trust.
46
Infection Prevention and Control
Safe, effective and systematic infection prevention and control measures are an important
component in health care. The prevention of infection is the primary goal when providing care
to patients and to ensure risk is reduced to healthcare staff. Much has been done to reduce
the risks of healthcare associated infections (HCAIs) in both the hospital and community over
the past years, and it is therefore essential that Bridgewater continues to ensure ‘infection
prevention’ continues to be seen as a priority.
Hygiene Code
The Trust is responsible for meeting the standards within Hygiene Code (Health and Social
Care Act 2008). We therefore believe that we are able to assure the Care Quality Commission
(CQC) that we can supply evidence of best practice which indicates how we are maintaining
a reduction in HCAI’s and supporting measures to improve environmental hygiene.
Dental health care and practice is monitored by ensuring care is managed against the
standards within the ‘HTM01-05: Decontamination in Primary Care Dental Practices
Guidance’.
As a Trust, we continue to support a philosophy of a ‘zero tolerance’ to avoidable HCAI. In
the past year to help us achieve this we have:
• Continued a programme of peer audit of hand hygiene in all staff with face to face
hands on contact.
• Achieved a second year with no MRSA bacteraemia infections
• Assisted in the reduction of avoidable Clostridium difficile infections
• Continued to provide education, audit and training regarding ‘Essential Steps to Safe
Clean Care’, the national programme of healthcare practice which helps staff to work
in a systematic manner to prevent infection. In particular using ‘Aseptic Non Touch
Technique’ (ANTT), for high risk procedures
• Worked across the health economy sharing best practice in infection prevention.
• Had a small improvement in staff flu vaccine uptake, but realise more needs to be
done
• Undertaken a programme of quality walk-round visits
• Responded to the risks from suspected Ebola infection.
Infection, Prevention and Control Team
At the beginning of 2014, the Infection, Prevention and Control (IPC) Team divided into two
distinct teams to ensure that clear lines of accountability were distinguished between the
commissioner and provider roles. The commissioner role is not covered in this report. The
Trust IPC team structure and lines of accountability can be seen below. The IPC service
reports directly to the Executive Nurse who is the Director of Infection, Prevention and
Control.
Two full-time IPC nurses are currently managing the provider service and a decision to
employ a third nurse is currently under review. The Trust IPC team has the responsibility for
providing advice, training and on-going support on infection, prevention and control to all
directorates and their services as well as other partner agencies, i.e. intermediate care
facilities jointly managed/utilised by the Trust.
47
IPC Structure and Lines of Communication/Accountability
Trust Board
Executive Nurse/Director of Governance
Quality and
Safety
Committee
Director of Infection, Prevention and Control
(DIPC)
Infection, Prevention and Control Lead Nurse
(band 8b)
General Managers and
Services
Infection, Prevention and Control Infection,
Prevention and Control (band 7)
IPC Nurse (vacant)
Infection, Prevention and Control Programme of Work
The annual Infection, Prevention and Control Programme of Work is developed and
monitored throughout the year. The work programme has a primary focus on policy
development, education and training, which outlines the structures required to share
information across the Trust from the Chief Executive to staff in the community and vice
versa.
All actions set within the work programme are developed to support the Trust in providing
evidence of meeting the criteria within the Health and Social care Act 2008. The last year has
been a challenging year for the IPC team, with a change to their management structure and
having to meet new priorities such as managing the staff flu programme and responding to
the Ebola outbreak. This is also the first year that the two infection prevention control nurses
have been responsible for supporting the management of IPC across the whole footprint,
which is extensive. Whilst most actions set were met, some goals were not, due to increasing
workload and changes to roles, these were:
• Ensuring there is a Trust wide Infection, Prevention and Control Group
• IPC Team to provide face-to-face update sessions to all teams
It is expected that both of these actions will remain in the 2015/16 plan and will be met as a
priority.
Internal Reporting Arrangements
The Quality and Safety Committee, that provides assurance to the Board, receives a quarterly
report and verbal update from the Lead Nurse infection, prevention and control and the
Director of Infection, Prevention and Control (DIPC).The Trust’s compliance against the
Health and Social Care Act, and key actions to meet best practice are noted at this
committee. This group has been made aware of the challenges encountered by the IPC team
and of the recommendations requested by the IPC team to support an effective service.
48
Reporting to Clinical Commissioning Groups
The Trust reports its compliance against the Health and Social Care Act to a number of
Clinical Commissioning Groups. Again the annual programme of infection, prevention and
control is the basis of this reporting mechanism, and any findings from outbreaks or single
cases of infection are discussed at this group. Action plans are scrutinised and clear dates
for response and completion of actions are set out.
Healthcare Associated Infection (HCAI)
The risk of obtaining a HCAI will always be a concern for patients receiving treatment across
the NHS. We have worked closely with our commissioners to monitor HCAI, and where a
lapse in care is thought to have occurred during the care we have provided, a full root cause
analysis (RCA) is always undertaken. At present we as a Trust participate in the national
mandatory surveillance programme for MRSA and Clostridium difficile infection. The diagram
below indicates infections attributed to the Trust.
HCAI Bridgewater Community Healthcare NHS
Foundation Trust 2014-15
1
March 15
February 15
January 15
December 14
November 14
October 14
September 14
August 14
July 14
June 14
May 14
April 14
0
Number of cases
of Community
acquired MRSA
cases attributed to
Bridgewater within
month
Number of cases
of Community
acquired C. difficile
cases attributed to
Bridgewater within
month
Methicillin Resistant Staphylococcus Aureus (MRSA)
The Infection Prevention and Control Team review all notifications of MRSA bacteraemia
(blood poisoning) infection, using a recognised Post Infection Review (PIR) tool. This helps
to fully investigate the patient’s journey, exploring the key contacts patients have had with
health care staff and their practices. No MRSA bacteraemia cases were attributed to the Trust
during 2014/15, this is the second year a nil return has been submitted and indicates a
continued effort by Trust staff to prevent infection MRSA bacteraemia in practice.
To ensure the Trust maintains a continued zero MRSA bacteraemia, staff are audited and
provide evidence of good hand hygiene in practice, undertake infection prevention
precautions such as aseptic technique and are supported by the infection, prevention and
control team.
49
Clostridium Difficile
Clostridium difficile (also known as ‘ C. difficile’ or ‘C. diff’) is a bacterium that can be found in
people’s intestines (their digestive tract or gut). It causes either diarrhoea (mild to severe) or
in some cases a life-threatening inflammation of the intestines. A person can become
infected with Clostridium difficile if he/she ingests the bacterium and this can be made worse
if they have taken a number of antibiotics which can disturb the normal bacteria in their gut.
The most effective way we can reduce Clostridium difficile infection is to reduce antibiotic
prescribing where possible, target infections with specific antibiotics, and ensure that when
antibiotics are prescribed, the full course is taken by patients. Good hand hygiene with soap
and water and environmental hygiene are also key in the fight against this infection.
As a community trust we do not have a target for reduction of Clostridium difficile but we are
expected to support acute trusts and commissioning organisations in meeting their goals.
Only one of the four Clinical Commissioning Groups we work with have set a threshold (see
the table below).
Clinical Commissioning Group
Ashton, Leigh and Wigan
Warrington
Threshold
Actual
No threshold set
0
4
0
Halton
No threshold set
0
St Helens
No threshold set
2
Over 2014/15, a number of cases of Clostridium difficile infection were investigated and two
of these were attributed to the Trust (please note that ‘attributed to the Trust’ signifies in these
cases that some care we provided could be improved rather than the Trust being directly
responsible for the infection). These two cases of Clostridium difficile infection had been
admitted to the Trust inpatient facilities and commenced with diarrhoea soon after admission.
The cases could have been avoided if use of aperients (laxatives) had been reviewed and in
the second case all staff involved had noted that this was a relapse of an earlier Clostridium
Difficile infection, rather than a new case and the patient treated accordingly. Learning from
these two cases have been noted and action plans completed to reduce future risk to
patients.
Ebola
All NHS Trust were asked to ensure that they have robust systems in place to educate the
public and healthcare staff in the management of patients suspected as having this infection.
For the Trust this has meant reviewing where patients are most likely to attend for advice, and
this we believed would be our out of hours services and walk in centres. The IPC team
distributed posters and information provided by Public Health England, ensuring this
information was visible as people attend our premises. Education sessions were then
provided by the IPC team to ensure staff were aware of the latest guidance and of how to
manage suspected cases, ensuring these staff were aware of key contacts. We have not
been involved in the management of any confirmed cases. The Trust IPC team will continue to
address any staff educational and support needs until the outbreak is declared over.
50
Outbreaks
Outbreaks of infection usually occur when people and patients come together. The Trust is
responsible for two inpatient facilities and we encountered a number of diarrhoea and
vomiting infections during the winter months, affecting both residents and staff. This seems
to have reflected the levels of diarrheal infection in the community at large which have caused
problems for our hospitals. The outbreaks were all found to be due to norovirus infection.
This is a particularly virulent (contagious) infection, which spreads easily between staff and
patients as it can be spread via both the bowel when suffering diarrhoea and aerosols from
the mouth when those affected vomit. During outbreaks of this kind it is important is to keep
patients hydrated and comfortable, maintain strict adherence to hand hygiene and other
infection, prevention and control practices, ensure staff stay away from work whilst affected,
close to admissions until the outbreak is declared over and to undertake a thorough
environmental ‘deep clean’ before reopening. These outbreaks have tested our practices,
policies and procedures and we have reviewed these in the light of the findings. Action plans
were set to ensure lessons were learned and these actions have been implemented to reduce
the risk of further outbreaks and to help us better manage those we cannot avoid.
Environmental Cleanliness
Infection control audits are undertaken in a cross section of clinics at least annually and
following each audit an action plan is written with recommendations for implementation.
Overall the audits indicate that the majority of our clinics demonstrate very good compliance
with national standards and satisfaction with our clinical services. Where issues were found
action plans were set to improve standards, often the issues were regarding clutter and
helping staff to manage their environment better. All of our cleaning contractors meet the
national cleaning standards and use a colour coding system to reduce the risk of cross
contamination and infection.
Quality walk-rounds
Patient safety walk-rounds were historically a way of ensuring that executives were informed
first hand, regarding the safety concerns of frontline staff. They are also a way of
demonstrating visible commitment by listening to and supporting staff when issues of safety
are raised.
Over the past year quality walk-rounds have been undertaken across the Trust footprint
involving a number of our adult, children and complex services. The process allows us the
opportunity to speak to staff and service users and for them to speak directly to senior staff.
Each visiting team includes a senior manager, non-executive directors (NEDs), IPC nurses,
estates and a patient representative. Each team member has a crib sheet of quality based
questions which help collect data on the service provided, highlight the successes and where
action is needed to improve the care we give. Any actions highlighted from the visits are fed
back to the executive team, staff groups and services to improve future practice. The process
has proved popular with our NEDs and patient representatives but requires review to ensure
that appropriate administration and support when organising the visits is in place. A key
element of the walk-rounds is to ensure that areas for improvement are identified and actions
set to improve care provided. These actions can be checked to ensure they have been
completed in the next round of quality visits.
51
Influenza Vaccination for staff
The Trust’s Lead Nurse for Infection, Prevention and Control along with colleagues from
communications ran a staff influenza campaign between September 2014 and February 2015
to encourage the take-up of the seasonal flu vaccine among staff and in particular frontline
staff.
The objectives of the 2014/15 seasonal flu campaign were:
• To meet the Department of Health, Public England target of 75% of frontline staff
employed by Bridgewater being immunised against seasonal flu
• To inform all staff employed by Bridgewater of the list of locations, times and dates
where they can have a free flu vaccination
• To inform all staff employed by Bridgewater about the benefits of having a flu
vaccination and address any questions they may have.
To meet these objectives a flu plan was devised and was structured to ensure that key
members of staff including those at director level, were aware that key to the success of this
programme was their individual and collective involvement. Over 100 staff vaccination
sessions were undertaken in clinics, at team meetings and ‘drop ins’, to ensure staff had
better access. A staff questionnaire was completed and this indicated that 71% believed that
there were enough flu sessions. Recommendations to improve uptake for 2015/16 are given
at the end of this section, however as it has now been widely reported that the vaccine this
year was not as effective to the strain that was circulating, fears are that this many have an
effect on flu uptake across the NHS.
The Trust campaign was run from the first week of September 2014 until the end of February
2015. In total 53% (n=1240) of frontline staff across Bridgewater were vaccinated during this
period. This is an increase of 8% on the previous Bridgewater 2013/14 flu season. Results by
service and borough can be seen below. Over 386 corporate non-clinical staff were also
vaccinated and whilst these staff are not counted in the official frontline figures, the Trust
supports them as they often encourage their clinical colleagues to be vaccinated.
Flu vaccine uptake by directorate
Total frontline staff
Total vaccinated
%
Adult
1153
614
53
Children
711
422
59
Specialist
483
204
42
Total
2347
1240
53%
Flu vaccine uptake by Borough
%
Ashton, Leigh & Wigan
60
Halton
45
St Helens
47
Warrington
48
To improve flu uptake in the coming year the IPC team have highlighted a number of issues.
An improvement plan will be in place and monitored through directorate and quality
management groups.
52
Safeguarding
The Trust has systems in place to ensure that patients and the public are safe. Safeguarding
assurance is provided through the Safeguarding Assurance Group which reports to the
Quality and Safety Committee of the Trust. The Safeguarding Assurance Group monitors
training, incidents, risks and supports the partnership working in relation to safeguarding
children and vulnerable adults. The group provides challenge to internal and external
processes and is chaired by the Trust executive lead for safeguarding. A recent audit by
Mersey Internal Audit showed that the systems and processes in place provided significant
assurance that people are safe in our care.
Safeguarding assurance is also provided to commissioners through the safeguarding audit
tool which is completed annually with quarterly reviews of performance by the
commissioners.
The Trust is represented on each of the local safeguarding boards and the staff involved in
safeguarding issues have good working relationships with local authorities, social services,
police and safeguarding teams. Multi Agency Safeguarding Hubs are providing integrated
safeguarding teams, promoting information sharing, shared assessments and targeted
delivery of services to families and young people.
The Trust follows national statutory guidance and local recommended practice for
safeguarding.
Safeguarding children and vulnerable adults is the key focus for our service.
The Safeguarding service provides:
• Advice, support, and training for Trust staff and external agencies
• Services for children in care – ensuring their health needs are identified and health
care plans are monitored
• Clinical and safeguarding supervision for staff within the Trust to provide support,
management and education to practitioners to improve practice for safeguarding
children and adults.
The organisation participates in multi-agency safeguarding inspections working with services
within local authority boundaries e.g. St Helens, Halton, Warrington, Wigan and Trafford. A
recent Ofsted inspection in Halton recommended that Care Leavers were aware of their right
to access health information about themselves and to be provide with a “health Passport”. All
Care Leavers are currently provided with this information before they leave care. The outcome
of a recent Ofsted inspection in Warrington is awaited.
In the last year the Trust has participated in several Serious Case Reviews for children, local
case reviews for adults and domestic homicide reviews; these are all on-going and the
learning from the reviews has been used to inform best practice in the organisation and in
partnership working.
53
Some of the learning which has been implemented into practice includes:
• A guideline for bruising and physical injuries in children has been developed and
communicated
• Improved communication processes in district nursing services; daily handover
process
• Shared risk assessments for non-concordant care
• Assessment of self-neglect
• Promotion and awareness raising of the escalation policy across partner agencies
• Multi-agency case file audits to recognise the impact of services working together to
affect change and improve outcomes for children
• Improved information sharing with GP practices and flagging of vulnerable children on
the computer records has been achieved
• We have reviewed Out of Hours GP information sharing processes and are
developing standard operating procedures for sharing of information with the
universal caseload holder when a child attends the OOH GP service on three
separate occasions in a given period (six months for pre-school children and 12
months for school age children)
• We have implemented safeguarding supervision for the Out of Hours GP service
• We have developed more robust IT processes with the acute Trust for the sharing of
information when children attend the emergency department or are discharged from
hospital
• The voice of the child is being heard, recorded and acted upon on a more consistent
basis
The Looked after Children service has now been incorporated into the Safeguarding Children
Team across all boroughs. Developments in this area have resulted in improved attendance
of children and young people for initial and review health assessments. Health needs are
being addressed sooner with an expectation of better health outcomes for children. Care
leaver passports have been developed to provide young people with a summary of their
health since birth, incorporating immunisations dates and relevant family history. Guidance is
given to educate young people regarding access to health care i.e. GP, dentist, sexual health
services.
National Institute for Health and Care Excellence (NICE)
Every month NICE publishes guidance that sets the standards for high quality healthcare and
encourages healthy living.
The Trust is committed to continually improving the quality of our services and the health of
our patients. By adopting a robust approach to implementing NICE guidelines service users
can be assured that their care and treatment is safe, up to date, and evidence based.
All newly published NICE guidance is distributed to services throughout the Trust to ensure
that services are compliant with NICE recommendations. Services evaluate each piece of
guidance and determine whether it is relevant to their service and if so, the service is required
to undertake a baseline assessment to state whether they are fully compliant, partially
compliant or non-compliant.
54
Services are given four weeks to undertake baseline assessments following publication of
guidance and a further four weeks if compliance is partial and an action plan needs to be
developed. Partial compliance means that there is one or more recommendation that the
service is not adhering to at present. This is to be expected in relation to newly published
NICE guidance. However, an action plan must be devised in order to bring the service into
full compliance.
In the year April 2014 to March 2015, NICE published 109 pieces of guidance, excluding
NICE Quality Standards, most of which related to care provided in acute hospitals. There
were 23 pieces of guidance applicable to services that the Trust provides. We were fully
compliant with 11 and action plans were put in place to bring us into full compliance with the
remaining 12.
Total applicable to Trust
services
23
Fully compliant
Partially compliant with action plan
to bring into full compliance
Not compliant
11
12
0
Compliance with NICE guidance is reported through the Quality and Safety Committee of the
Trust Board. Clinical audits of NICE guidance are included in the annual clinical audit plan.
Below is an example of an audit that was completed to check compliance with NICE
guidance.
Audit of Nocturnal Enuresis (NICE CG 111 “Nocturnal Enuresis: the management of
bedwetting in children and young people.”
The audit was undertaken in the Children Continence Service provided in the Halton and St
Helens area. It revealed good practice in comparison to NICE recommendations but
highlighted a couple of areas where improvements could be made. In particular, standard 1
– see table below. All 21 items had to be documented for the standard to be met and in 59%
of cases, they were all there. The service is moving paper health records to an
electronic patient record and has reviewed the electronic system to ensure that all of these
assessment questions are included. This will act as a prompt to ensure that specific
questions are not omitted. A further audit will be undertaken in 2015 to ensure that this
compliance percentage has improved as anticipated.
Compliance
1
2
3
4
5
6
Assessment and Investigation – this standard contained 21 individual items relating to
bedwetting history, daytime symptoms and toileting patterns. If even one of these 21
items was omitted, the standard was recorded as not met.
The clinician should assess whether the child or young person has any comorbidities or
there are other factors to consider
An alarm should be offered as the first-line treatment to children or young
people with bedwetting.
The response to an alarm should be assessed by 4 weeks.
Alarm treatment should be continued in children or young people with bedwetting who
are showing signs of response until a minimum of 2 weeks’ uninterrupted dry nights has
been achieved.
The appropriateness of continuing with alarm treatment should be assessed if complete
dryness is not achieved after 3 months.
59%
94%
82%
100%
100%
100%
55
NICE Quality Standards
NICE Quality Standards are a different type of publication to be used by providers and
commissioners in the design and delivery of services. NICE Quality Standards are to be used
to engender quality improvements and, unlike other NICE guidance, are not for compliance
purposes.
A two pronged approach was implemented from 2014/15 so that the Trust can keep up with
new Quality Standards published each month while at the same time address NICE Quality
Standards that had previously been published.
By the end of March 2015, there were a total of 83 NICE Quality Standards. 73% of these are
applicable to care provided by one or more of our services. A phased prioritised approach
is underway to gather evidence against each one, so that plans for improvement to service
delivery can be made.
Clinical Audit
Clinical audit is a quality improvement process that seeks to improve patient care. This
means the care that patients receive is reviewed against standards which are proven to be
best practice (evidence based care). This is carefully evaluated and where required, changes
are made to improve care.
We believe that it is our responsibility to provide our patients with good quality, safe and
effective care in order to achieve the best outcomes.
We need to identify areas that can be improved and address those as a matter of priority.
The clinical audit plan is presented to and overseen by the Quality and Safety Committee.
Progress is reported on a quarterly basis and includes key findings from individual audit
projects along with the main priorities in the associated action plans.
Topics included in the clinical audit plan are identified from:
• National priorities for example an NHS England national audit or NICE guidelines
• Local priorities, for example an incident report, a patient complaint or a concern from
any other source.
• Commissioner priorities.
The example below is an audit which reflected one of our commissioner’s priorities.
Audit of Efficacy of the Growth and Nutrition Service
The Child Growth and Nutrition Service is a specialist nurse led clinic for obese children,
established in St Helens in 2004. It was expanded to cover the Halton area in 2011. Children
aged 4-16 years who meet the referral criteria are eligible to attend. The aim of children’s
weight management, for the majority of children, is to maintain their weight whilst they
continue to grow in height until their height and weight is in proportion and their BMI is within
the healthy range. In extreme obesity or once a child reaches puberty the aim would be a
small weight loss of 0.5-1kg per month until their height and weight is in proportion and their
BMI is within the healthy range.
56
The standards used to measure the care are contained within:
• NICE 43 (2006) - Obesity: Guidance on the prevention, identification, assessment and
management of overweight and obesity in adults and children
• SIGN 115 (2010) - Management of Obesity
• Bridgewater clinical guidance: Child Growth and Nutrition Service for Clinically Obese
School Age Children (4-16 years) (2011), HStHCL284. Last updated 2014
The service has undertaken clinical audit over several years previous to this final one. Earlier
cycles of audit have focussed on whether the service met the needs of the families referred,
behaviour change and effect on BMI. Later audits focussed on clinical care, specifically the
identification and management of obesity related co-morbidities. Over all of the cycles of
audit, the percentage of children in the extreme obese category has reduced from 13.33% to
1.11%.
The results as detailed in the table below show 100% compliance with 10 out of 11
standards. One out of the five elements in Standard 9 does not achieve 100% and that is
the urine sample tested for the presence of glucose and protein. Patients were being asked
to bring a urine sample to clinic. In the cases where the test was not done, it is noted that a
specimen was not provided. The service has already changed practice and now asks for the
urine specimen to be provided in clinic rather than brought along to clinic.
At the review appointment the BMI score improved or was maintained in 63% of children.
Reasons were documented in relation to the remaining 37% such as not achieving the
required exercise levels, family situations such as holidays, family breakdown, emotional
difficulties, comfort eating. These reasons illustrate some of the challenges the service must
address and the range of support needed by families and children.
In addition to the information provided in the table below, parents and children were asked
via questionnaire for their feedback which shows that:
• 93% of parents reported attending the clinic helps to support the family with behaviour
change
• 100% of parents reported having an agreed action plan with realistic goals. A number
of parents said they did not have a written copy but would have liked one. In
response to this, the service is now offering a written action plan whilst in clinic. This
will result in improved communication with parents and children thereby ensuring
patient safety and patient involvement in care
• 93% of parents reported that their child was involved in decisions about their care
• Children were asked how they felt about more exercise, changes in diet and attending
clinic. They were also asked what changes they had made. Their feedback shows
that they are making the recommended changes although they are not always happy
to do so
• When asked 86% of the children said if a friend needed the same kind of help they
should come to this clinic. The remaining 14% of the children said maybe.
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1
2
3
Standard
Referral criteria must be met in all cases (includes aged 4-16 and BMI ≥98th Centile)
On receipt of referral an appointment is to be offered within 8 weeks from referral
At initial assessment an holistic assessment which will include:
• Birth history
• Past medical history
• Current medical concerns
• Medication
• Allergies
• Immunisation status
• Environmental factors and Social and family factors
• Assess family history of obesity and comorbidities
100%
97%
93%
4
Medical Examination
• Height weight and calculation of BMI
• Waist measurement and abdominal girth
• Respiratory, cardiac, abdominal examinations
• Pubertal development, signs of acanthosis nigricans, hirsuitism or cushings syndrome
• Signs and symptoms suggestive of type 2 diabetes
• Routine urinalysis
92%
5
If clinically indicated, children should be signposted to Tier 2/3 Primary Mental Health Service as
required for appropriate support. Emotional and wellbeing assessment done via strengths,
difficulties and short moods and feelings questionnaire.
100%
6
“Physical activity levels” should be discussed with child and parent and documented within the
patient record.
100%
7
“Dietary intake” was discussed with child and parent and documented within notes
100%
8
All children to have an agreed care plan with achievable goals and timescales with letter of
discussion sent to parent, GP, school nurse and any other professional.
100%
9
Clinical investigations
• Urine sample tested for the presence of glucose and protein
• Children are referred to the paediatric day unit /phlebotomy for a fasting serum glucose
level if they present with any of the following:
- a family history of Type 2 diabetes or maternal gestational diabetes
- acanthosis nigricans
- BMI >99.6th centile
• Children are referred to the paediatric day unit/phlebotomy for a fasting lipid profile if
they present with any of the following:
- a family history of dyslipidemia
- a family history of ischaemic heart disease
- BMI >99.6th centile
• Children are referred to the paediatric day unit for a glucose tolerance test if the child
presented with appearance of Acanthosis Nigricans
• Thyroid function (TSH) will be checked if the child is short for height and there is a
family history of auto-immune disorder e.g. coeliac disease, hypothyroidism or type 1
diabetes
88%
10
All children must be seen within 6 to 12 months following the first assessment and reviewed
100%
11
All children discharged from services are to have at least one of the following:
• BMI<98th Centile
• Parent/ child choice
• Child reached 16th birthday and will transfer over to adult pathway
• Transferred out of area
• Non-attendance at clinic following one DNA unless the staff member is aware of
any exceptional mitigating circumstances or following two consecutive cancelled
appointments
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100%
Research
During 2014/15, The Trust has expanded its research portfolio and is now participating in
dental research and studies relating to prison healthcare. In addition, eligible Trust patients
have been able to participate in a number of important national studies into areas such as
rehabilitation following stroke, autism and ADHD, heart failure in older patients, and a Down’s
Syndrome feeding study.
The Trust has received recognition from the Health Services Journal and National Institute for
Health Research (NIHR) for the contribution we have made to promote clinical research in the
Trust; one important aspect of which is providing our patients with opportunities to participate
in research. To this end, the Trust has participated in the Department of Health’s ‘OK to Ask’
about clinical research and international clinical trials campaigns.
Bridgewater clinicians continue to use research evidence to inform their clinical practice.
The number of research active staff continues to increase, via assisting the identification and
recruitment of patients into studies, initiating research, and registering for higher research
degrees, such as doctorates or NIHR Clinical Masters in Research. During 2014/15, Trust
staff have also published their work in books and journals, and presented at conferences.
Examples of this research has considered screening for cardiovascular risk factors in
patients with psoriasis, implementing NICE guidelines for childhood eczema, and
incorporating Yoga into physiotherapy practice as an extension of therapeutic exercise.
Care Quality Commission – Essential Standards for Patient
Safety and Quality
Throughout 2014/15 the Trust has continued to declare full compliance with the essential
standards and remains registered, without conditions, with the CQC.
Quarterly reports on compliance across the Trust have been submitted to both the Quality
Management Group and the Quality and Safety Committee.
To facilitate the reporting of compliance from service level up to the above committees we
have continued to utilise our CQC Monitoring Framework. This framework sets out the
expectation that our clinical services are accountable and responsible for monitoring and
reporting compliance with the essential standards. Compliance is reported up through the
directorate management structures and where necessary appropriate actions are undertaken
to address any identified areas for improvement.
In order to check compliance at service level we have continued to carry out our own internal
CQC Service Reviews. During 2014/15 there were 24 reviews undertaken. The review
panels consist of a member of the governance team and a service manager. The panel
discuss compliance against all the outcomes with the relevant clinical manager. The reviews
take approximately 2.5 hours and whilst they cannot be seen as “deep dives” into each
service they do facilitate an increased awareness of “what good looks like”. Following a
review, the service is provided with an action plan identifying areas for improvement. All the
action plans are monitored within the relevant directorate structure and via the quarterly
reports through to completion.
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Care Quality Commission Inspections
In February 2014 the Trust was the first community health service to be inspected in the North
as part of the Wave 1 pilot inspections of NHS community health providers.
Overall, the CQC inspection found that the Trust provided safe and effective community
health services which were well-led with a clear focus on quality. However, the regulator
found some weaknesses in risk and quality reporting and action taken following the
identification of risks at Newton Community Hospital.
The final CQC inspection report published on 17th April 2014 included one compliance
action as follows:
Regulation 10 HSCA 2008 (Regulated Activities)
Regulations 2010 Assessing and monitoring the quality of service provision.
The provider has not protected people by means of an effective operation of systems
to identify, assess and manage risks relating to the health, welfare and safety of service
users at Newton Community Hospital.
Regulation 10(1)(b) and 10(2)(c)(i)
As expected, the report also identified some specific areas where we needed to make
improvements to systems and processes. An action plan was submitted to CQC to address
CQC’s Areas for Improvement (“Must do’s, Should do’s and Could do’s”). This action plan
was monitored by both the Quality Management Group and the Quality and Safety
Committee to ensure all the required actions were undertaken.
CQC identified two “must do’s”;
• Develop effective reporting mechanisms to ensure that the board are fully sighted on
activity and performance at Newton Community Hospital.
• As a result a Quality Dashboard was developed which is submitted as part of the
Integrated Performance Report to the Quality and Safety Committee.
• Develop effective systems to identify, assess and manage of risks at Newton
Community Hospital.
• All Newton Hospital specific risks are recorded on Ulysses (the organisations
electronic risk management system) and discussed with staff at the weekly
multidisciplinary team meetings.
The Trust declared compliance against the above compliance action in March 2015.
St Helens Clinical Commissioning Group Review of Newton
Hospital
The CQC inspection of the Trust in February 2014 found some gaps in risk and quality
reporting at Newton Community Hospital. Consequently, St Helens Clinical Commissioning
Group (CCG) made a request to carry out an inspection visit of the inpatient ward at Newton
to provide them with assurance that any issues identified by the CQC had been addressed.
The visit took place on the 5th November 2014. The inspection team included several
members of the CCG along with two Healthwatch representatives.
60
All the members of the team were provided with information prior to the visit so that they
could spend the time on the ward with patients and staff.
The ward was busy but the team found the staff very accommodating, friendly and
welcoming. The patients that the inspectors spoke to were very positive about the quality of
their care and the team saw staff treating patients with compassion, dignity and respect.
Areas for improvement included the need to develop the environment to be more dementia
friendly and to make patient documentation simpler and clearer, both of which are being
taken forward. As a result of the visit the ward team are now producing a vision for Newton
Hospital which will identify goals for the ward team to achieve which will be monitored by the
Bridgewater executive board and at the St Helens quality meeting with the CCG.
Medicines Management
Incidents
The Bridgewater Medicines Management Team continues to work closely with healthcare
professionals to ensure patient safety and quality care with respect to medicines use. The
Trust supports an open culture encouraging the reporting of medication incidents and also
interventions made to avoid possible errors.
The detailed review and analysis of reported medication incidents is a fundamental aspect
of the work of the Medicines Management Team, supported by the Risk Management Team.
Following an initial detailed analysis and classification of incidents, by the Medication
Incident Panel, incidents are discussed at the Medicines Management Groups (both internal
Bridgewater meetings and interface meetings involving pharmacist representatives from the
local CCGs) and the Quality Management Group to identify themes and review the lessons
learned measures put in place to minimise incidents.
In 2014/15, 250 medication related incidents were reported by the Trust staff including 28
involving controlled drugs. They include ‘third party’ incidents which Bridgewater staff
identified but originated from other healthcare providers e.g. hospitals, community
pharmacies, GPs, care agencies or individuals. The reporting of these third party incidents
demonstrates continued vigilance by Bridgewater staff regarding the safety of medicines
within the community.
The graphs below summarise the total medication incidents and the controlled drug
incidents reported by severity, respectively.
61
Medication Incidents by Month and Severity
30
u
25
20
15
u
s
s
s
u
u
u
s
February 15
January 15
October 14
September 14
August 14
July 14
June 14
s
s
March 15
s
u
s
u
s
s
u
u
December 14
u
s
November 14
u
May 14
5
0
u
u
April 14
10
s
(0) Near Miss
(1) No Harm
(2) Minor
(3) Moderate
Total
Controlled Drug Incidents by Month and Severity
7
6
(3) Moderate
(2) Minor
(1) No Harm
(0) Near Miss
5
4
3
March 15
February 15
January 15
December 14
November 14
October 14
September 14
August 14
July 14
June 14
May 14
1
0
April 14
2
Third party incidents and administration of medications are the main types of incident
reported. It is well known that medication issues are most frequent when a patient moves
from one place of care to another and often due to lack of communication e.g. breakdown in
communication on transfer of patients between organisations. The Trust’s Medicine
Management team has established closer links in 2014/15 with local trusts to report relevant
third party incidents for appropriate investigation and to facilitate lessons learnt being shared
across the health economy.
As a result of the medicines management review of medication incidents the Trust is able to
review procedures and policies to ensure any changes are implemented. Incidents are dealt
with on a case by case basis with staff involved undergoing a review and assessment of their
practice using the medicines competency framework.
Non-Medical Prescribing
A Non-Medical Prescriber (NMP) is a registered healthcare professional who has specialist
knowledge and skills and who has undertaken additional training to become a qualified
prescriber. The Trust currently has ~450 non-medical prescribers who work to ensure
patients have timely and appropriate access to medication and have individualised evidence
based care.
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The North West Non-Medical Prescribing Leads Network commission an annual audit and
NHS healthcare organisations across the north west are invited to take part in this regional
clinician’s online audit for non-medical prescribers. The standards set for this audit were
developed at the inception of the audit in 2009 and were linked to the Care Quality
Commission Outcome 9 (Medicines Management) and 16 (Assessing and monitoring the
quality of service provision). The main aims of taking part in the audit are to provide a source
of evidence that helps to identify areas requiring improvement and to demonstrate the
importance of having prescribers who can deliver care where and when it is needed thus
enabling them to complete the episode of care.
Within Bridgewater, 51% of non-medical prescribers took part in the 2014 on-line clinician’s
audit. Participants were asked to complete each audit as soon as possible after seeing a
patient (consultation).
229 (51%) non-medical prescribers took part in the audit compared with 26% in 2012 (there
was no audit in 2013 due to updating of the audit tool and national organisational changes).
The following information indicated how non-medical prescribers are key in the delivery of
care at the point of contact:
• 38% contacts prevented a GP surgery appointment
• 26% contacts prevented a GP home visit
• 10% prevented follow up to another healthcare professional
• 6% prevented re-admission
• 5% prevented attendance at A&E
• 4% prevented of new referral to another healthcare professional
• 3% prevented of admission (hospital or hospice)
• 2% prevented of walk in centre visit
• 2% prevented of follow up by consultant (or team)
• 1% prevented of visit to minor injuries centre
• 1% prevented of new referral to consultant.
The results of the audit have been shared with all of the prescribers and individuals have
access to their own prescribing report to allow them to review any areas of their prescribing
practice where improvement can be made.
The impact/outcome of consultation results highlight the value of non-medical prescribing in
practice within Bridgewater and for their patients. This approach enables health
professionals and patients to utilise their time more effectively and reduce the number of
appointments patients may otherwise need to attend.
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The Trust understands our service users provide their personal information to us on the
understanding we will treat it confidentially and keep it secure.
Information governance (IG) provides a framework to bring together all the legal rules,
guidance and best practice that apply to the handling of information, allowing:
•
•
•
•
•
Implementation of central advice and guidance
Compliance with the law
Year on year improvement plans
Best practices in handling and dealing with information
Safeguards for, and appropriate use of, patient, staff and business information.
The Trust has an on-going, rolling IG assurance programme, dealing with all aspects of
confidentiality, integrity and the security of information. As a core part of this, IG training is
mandatory for all staff, which ensures that everyone is aware of their responsibility for
managing information in the correct way.
The Trust has carried out significant work in developing an overarching IG agenda. This
incorporates the Quality and Safety Committee which has responsibility for overseeing IG
at a strategic level with the Information Governance Subgroup assigned responsibility at an
operational level.
In 2014 the Trust had three data breaches, including loss of patient identifiable data.
Security of patient and staff information is considered to be of paramount importance to the
Trust. The three data breaches were thoroughly investigated and as a result of the
investigations, processes and procedures were reviewed, and all staff were asked to
undertake the ‘Secure Transfer of Personal Data’ eLearning module. Lessons learned
following the investigation were communicated to all staff via monthly Team Briefs and staff
meetings. The data breaches were reported to the Information Commissioners Office (ICO)
via the Information Governance Toolkit, as ‘Serious Incidents Requiring Investigation’ (SIRI).
The Information Commissioner’s Office (ICO) conducted a thorough investigation into all
three incidents and was satisfied that the Trust had taken the necessary measures to
minimise the risk of any further data breaches, and concluded that the three incidents did not
meet the criteria set out in their Data Protection Regulatory Action Policy necessitating further
action.
In 2014, the Health and Social Care Information Centre (HSCIC) set up a Caldicott2
Implementation Monitoring Group (CIMG) team in response to Dame Fiona Caldicott’s review
and the Government report, Information: To Share or Not to Share in 2013. The Trust fully
supports the CIMG to ensure the recommendations in the report are acted upon by
submitting an assurance report to the CIMG on a quarterly basis.
The Trust is proactive in information sharing for care purposes with the local health economy
across the entire Bridgewater patch. The Trust has in place documented protocols to ensure
information sharing has a secure legal basis, is ethical and secure and most importantly, staff
involved in the process of information sharing understand the process and are confident in
ensuring all sharing is in the best interests of the patient.
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Emergency Preparedness, Resilience and Response (EPRR)
As a provider of NHS-funded healthcare, the Trust has defined roles and responsibilities
under the Civil Contingencies Act 2004, the Health & Social Care Act 2012, NHS England
Emergency Planning Framework 2013, NHS England Core Standards for EPRR 2014 and
other associated guidance.
All NHS-funded organisations must identify a Board-level Accountable Emergency Officer
(AEO) who is responsible for ensuring they comply with legal and policy EPRR requirements.
The Trust’s AEO is the Chief Operating Officer, who is supported in discharging these duties
by the Head of EPRR.
We have an Emergency Planning Steering Group to coordinate and oversee the EPRR
function and ensure that we have major incident, business continuity and other emergency
plans which are regularly reviewed and tested. This group also monitors the action plans we
have in place to address any areas for development which have been identified.
For further information relating to EPRR please see the 2014/15 Annual Report.
Partnership Working
Health and Wellbeing Boards
The Trust is delighted that we are invited to attend the Health and Wellbeing Boards in each
of the towns we serve.
This is not universally the case in England, but it is extremely helpful for providers to be
present when Health and Wellbeing Boards are setting priorities for their populations and to
be able to contribute to their conversations about what is feasible, what is desirable and how
best to work together to achieve their aims.
Each borough has asked for a local as well as a “global” breakdown of our quality
performance reports and we discuss quality at a borough–level with each CCG quality lead
regularly, throughout the year.
Work with Halton’s Children Trust Partnership
Bridgewater have been working with local council colleagues in the Halton Borough to
develop a more joined up service for families, children and young people who have more
complex needs that require services from a number of agencies.
A time limited working group, including parents, children centres, family support, early years
schools, Common Assessment Framework support and health services was set up to look
at what would be best for Halton families’, children and young people. A service manager
from the Bridgewater children’s services team led the redesign work. The result has been
the creation of three newly organised 0-19 early intervention teams, which started to work
together in September 2014. The service is available to children, young people and families
in Halton. This is the first step towards integration of health, education and social care teams.
Development continues to be led by the Children Trust Partnership to make sure that services
are easy to access and delivered in a way that helps children, young people and families.
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Warrington Children’s Community Respiratory Team (CCresT)
During 2014/15, Bridgewater and Warrington and Halton Hospitals Trust collaborated to
develop a new service to help the youngsters of Warrington who are troubled by recurrent
wheeze or diagnosed with asthma.
CCResT, which opened its doors in April 2015, aims to keep care close to home, reduce the
number of interactions with secondary care and improve self-management of the condition.
Through detailed assessment and a personalised education plan, these children will be
enabled to lead as normal a life as possible and reduce the number of exacerbations of their
disease.
Assessment and education will be delivered by staff experienced in the care of respiratory
disease, having previously delivered a similar service based at Warrington Hospital. The care
will be provided by both paediatric respiratory nurses and physiotherapists who are
passionate in delivering high quality care.
Following a detailed initial assessment, further consultations will be offered to evaluate the
impact of changes in care. Once improvement has been confirmed the children will be
referred back to their GP for further review and management. In certain circumstances
CCResT will be able to refer directly onto paediatric consultants if this is felt to be necessary.
Warrington GP Extended Hours Service
“Access, demand and capacity” is one of the ten priority areas established by the GP
membership for the Warrington CCG Primary Care Strategy. As part of the Prime Minister
Challenge Fund (PMCF) initiative, Warrington Health Plus Community Interest Company
(CIC) is working in partnership with Bridgewater to establish a service that helps meet this
priority. In November 2014, together we successfully established the GP Extended Hours
Service, as a pilot from our Bath St Health and Wellbeing Centre. This pilot provides access
to GP appointments outside core practice hours, seven days a week.
Through this pilot we have learnt how best to work with GP practices on providing a
non-urgent appointment service, particularly the process that allows a safe and effective
patient journey. Through this work, we have identified demand and capacity issues that every
GP practice is facing in core hours, as many patients are requesting same day
appointments. As a result, Bridgewater is currently working in partnership with Warrington
Health Plus team to support the implementation of the second stage of this project, which
will address the demand for same day GP appointments.
Wigan District Nurse Liaison Team
The District Nurse Liaison team are based within Wigan Hospital. The role of the team is to
aid in providing a seamless discharge from hospital to their own homes or future home (e.g.
care homes etc). This is carried out by attending the wards on a daily basis and discussing
referrals into the community with the ward staff and assisting in liaising with the district
nursing teams when planning discharges.
The nurses are experienced former community nurses with a wealth of knowledge and
experience and provide education and links to the ward staff thus facilitating efficient
discharges.
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Care Home Support Team
The Warrington Care Home Support Team work in partnership with care home managers,
other professionals from within Bridgewater, GPs, colleagues from Warrington Hospital, and
social services.
The team undertake rapid specialist assessment of patients within residential and nursing
homes that have acute/unstable conditions who are referred to the team as an alternative to
a GP visit or hospital admission. They also make recommendations for the nursing
management of patients in care homes ensuring best practice and a high standard of
nursing care is delivered. This involves communicating with patients, relatives, agencies and
the multidisciplinary team, regarding patient care and acting as an advocate for individual
management of patients.
To ensure care plans are met and patients have access to specialist services they work as
part of the multidisciplinary team, working with other healthcare professionals and Social
Services as required.
The team also provide education and support to staff within the care homes to enable them
to provide quality care to the care home patients.
The team raise any concerns with the safeguarding team and attend relevant safeguarding/
best interest meetings alongside partners in social care.
One of the care home support team is a Care Home Discharge Facilitator based in
Warrington Hospital. They review those clients that have been admitted to hospital to
ensure that discharge planning is commenced appropriately, avoiding delays to the
discharge. They will also assist in arranging any specific equipment or training if the client’s
needs have changed during the hospital stay to ensure they can safely return home.
Introduction of the Northwest Ambulance Service (NWAS) Pathfinder Service (Wigan)
As part of a successful winter pressures bid, Leigh Walk-In Centre (WIC) introduced the
NWAS pathfinder service in November 2014. The introduction of a doctor within the service
has aided A&E avoidance schemes and provided an alternative destination for NWAS staff to
bring their patients. During February 2015 Leigh WIC were able to divert 53 out of 54 patients
(98%) referred to them by NWAS away from A&E.
In addition, referral rates to A&E from Leigh WIC have reduced; in October 2014 Leigh saw
3437 patients and referred 147 (4.2%) to A&E. In January 2015 they saw 3490 patients and
referred only 86 (2.40%). The rate of referral has remained 2.2 - 2.4% since November 2014.
Intravenous (IV) Therapy Teams (Warrington, St Helens, Halton and Knowsley)
IV Therapy Teams provide acute care, previously only available in a hospital setting in
patients own homes and local clinics.
The benefits of a community IV Therapy service according to Chapman et al (2011) include:
•
Admission avoidance and reduced length of stay in hospital (with resulting
increases in inpatient capacity and significant cost savings compared with inpatient
care)
67
•
•
Reduction in risk of healthcare-associated infection
Improved patient choice and satisfaction.
The service actively in-reaches into local acute trust wards to promote the service and help
identify patients suitable for home treatment which facilitates discharge.
The service has no waiting lists, first visit community doses can be administered the same
day once the referral document is received. Once the patient returns home and contacts the
team, a venous access device can be inserted and the first community dose can be
administered within the comfort of the patients own home.
Initially, when the IV service was set up the majority of referrals were received from an acute
setting. Medically stable patients were referred to the service and their lengths of stay as an
inpatient reduced. Conditions treated include osteomyelitis, infected joints, endocarditis,
abscesses and meningitis etc.
However, as the service has grown an increasing number of patients are being referred
directly to the service by their GP, community matron and outpatient clinic settings. This
avoids a hospital admission. Conditions treated include skin and soft tissue infections,
bronchiectasis, urinary tract infections, acute dehydration and hyperemesis gravidarum etc.
Patient feedback on the IV Therapy Service:
• “The service was invaluable to my husband and without it he would not have realised
his final wish to spend his last days at home”
• “This service is great, without it I would have had to stay in hospital for two weeks
solely for intravenous antibiotics. All the staff I have met have been very professional
and pleasant”
• “I didn’t have to go the hospital. I had the treatment in the warmth and comfort of my
own home”.
Specialist Community Rehabilitation Service Hub and Spoke Model
Historically, in Cheshire and Merseyside, patients with complex rehabilitation needs requiring
community rehabilitation following discharge from a specialist unit or acute trust, experienced
prolonged waiting times for community generic or neurological therapy services, as well as
significant variations in access and quality of care. Limited provision impacted on patients’
clinical outcomes resulting in longer term recovery, reduced opportunity for independence
and increasing potential for readmissions to acute hospital.
Following the implementation of the Cheshire and Merseyside Major Trauma Collaborative,
a rehabilitation pathway was developed to address the increased demand for rehabilitation
requiring a specialist multidisciplinary approach across inpatient, outpatient and community
services.
Bridgewater Community Specialist Rehabilitation Services (BCSRS) are managed as part of
a co-ordinated whole system model of care which includes the following levels of specialist
rehabilitation services and partner organisations:
• Hub Hyper Acute Rehabilitation Unit and Complex Rehabilitation Unit (The Walton
Centre Foundation Trust);
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•
•
•
•
•
•
The Phoenix Specialist Rehabilitation Spoke Unit (The Royal Liverpool and
Broadgreen NHS Hospital Trust);
Elyn Lodge Specialist Spoke Rehabilitation Unit (St Helens and Knowsley NHS
Hospital Foundation Trust);
Oak Vale Extended Specialist Rehabilitation Unit (Health and Social Care
Partnerships);
Community Specialist Rehabilitation Services (Bridgewater NHS Foundation Trust,
Merseycare NHS Trust
Liverpool Neuro.
The service is commissioned for patients with highly complex rehabilitation needs who
require specialist multidisciplinary intervention following traumatic injury and illness within
their own homes for a period of up to 12 months. Whilst the service was commissioned in
April 2013, the team has evolved to reflect the needs of the patient group. The
multidisciplinary team includes occupational therapists, physiotherapists, neuropsychology
and clinical psychology, rehabilitation assistants and a case manager.
The team focuses on individual goals for the patient which extend beyond activities of daily
living. They encompass returning to work, education and management of social and leisure
time.
This pathway is unique. No other national pathway encompasses a number of providers
who focus on delivering seamless care and rehabilitation from the acute episode through
intensive rehabilitation in the hub/spoke inpatient units through to extended and community
rehabilitation.
Implementation of Community Care Plans in Halton and St Helens
In Halton and St Helens there were two new CQUINs for community nursing this year. An
integrated care one for long term conditions for patients under 65 and a frailty CQUIN for
patients over 75.
They have resulted in the services working closely with the North West Ambulance service on
the development and implementation of community care plans, for those patients who
frequently call emergency services in crisis situations.
Individualised care plans have been developed with the patients and carers detailing the
patient’s condition, what changes to look out for, and rescue steps if the patient needs help.
The care plans are also shared with GPs. The aim of the care plans is to prevent the patient
being transported to hospital during crisis situations. The care plans are uploaded onto an
electronic system so services can access the information and a copy is left with the patient
ensuring the ambulance service has all the necessary information and a rescue plan when
they are called out.
Traditional care planning no longer meets the needs of complex patients. The community
matron team have developed self-care plans for patients with long term conditions and all
the patients are involved in identifying their needs and developing their care plan. The “I”
statement enables the patient, carers and clinicians to detail what aspects of the plan they
can do and what aspects require support from others. The I care plans have resulted in clear
understanding for patients of the care that will be provided and it provides them with control
over their health and well-being.
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Patient survey results have shown that patients are showing an increase in confidence in
managing their own care.
Service Improvements (including new or significantly revised services)
New Urgent Care Centre
During 2014/15 Bridgewater has been working very closely with other local healthcare
providers and commissioners to improve urgent care services offered in the Widnes area.
As a result of this collaboration the new Widnes NHS Urgent Care Centre (UCC) will open in
late summer 2015 in the Health Care Resource Centre, Oaks Place Widnes and will be open
7am – 10pm, 365 days of the year. UCCs are community-based primary care facilities which
provide access to urgent care for a local population. The aims of the UCC include making
care easier to access closer to home and helping people avoid making unnecessary visits
to A&E. There will be increased numbers of doctors, nurses and other practitioners working
within the UCC and they will have access to X-ray, ultrasound and other diagnostic services;
enabling them to treat a wider range of conditions and injuries in an effective and timely
manner and meet the needs of our population.
Work to reduce falls in Newton Hospital
In the last twelve months Newton Hospital in-patient unit has been working hard to support
patients who are assessed as being high risk of having a fall.
The ward has undertaken weekly audits for the past eight months and established that 96%
of patients have been assessed as high risk of falls.
Patients are admitted to the ward often due to falling in the community or following
orthopaedic surgery following a fall, the aim of the ward is to maximise patient’s
independence and functional ability so that where possible patients can return safely to their
own homes.
In the past twelve months the ward has reviewed practice and implemented the following to
support falls prevention;
•
•
•
•
•
•
•
•
•
•
Offering patients falls prevention slipper socks
Purchasing falls monitors
Where possible placing patients who are high risk of falls in a more visible area
Weekly audits of falls assessment forms
Increase staffing when patient demand requires it
Development of patient information leaflets
Daily multidisciplinary meetings which discusses every patient on the ward
Three times a week multidisciplinary ward rounds
Undertaken a priority audit assessing falls prevention processes against NICE
Guidance
Currently participating in developing ‘FallSafe’ Care bundles which provides falls
prevention and management guidance approved by the Royal College of Physicians
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The chart below demonstrates the number of falls over the past twelve months on the ward.
This shows there has been an overall reduction.
NB this data includes all falls activity including near misses and lowering to the floor.
16
u
14
12
u
10
8
6
u
u
u
u
u
u
u
u
u
March 15
February 15
January 15
December 14
November 14
October 14
September 14
August 14
July 14
June 14
u
May 14
2
0
u
April 14
4
Day
Night
Linear (Day)
Linear (Night)
Willaston GP Practice
On 1st July 2014, Bridgewater took over the management of the Willaston Surgery in Wirral.
Willaston has a well-established team and offers a full range of primary care services.
Since July 2014, it has been our objective to maintain and strengthen the team and the work
they do. This can be evidenced with the continued high levels of satisfaction outlined in the
bi-annual GP patient survey.
From the outset we have committed to exploring ways of working more closely with the team
to help them deal with their workload and respond to changing patient needs. For example,
the practice has introduced an early visiting service, with the aim to undertake home visits
in the morning and if possible avoid hospital admissions. If a hospital admission is required,
there is a better chance of an earlier discharge.
Building on the well-respected patient participation group, Bridgewater has continued with
the ongoing positive patient engagement via the patient participation group.
This involves continually seeking their views on the delivery of the services offered to the
patients of Willaston. This commenced with a village meet and greet on 1st August 2014
at which the senior Bridgewater team met with local people and their representatives. This
proved to be a positive event, providing the opportunity for patients to ask questions of
Bridgewater. This commitment has continued with well attended patient participation group
meetings that take place every six months.
Speech & Language Therapy in Halton
The Speech and Language Therapy (SLT) Department in Halton have been actively involved
in seeking feedback from their service users, and using this feedback to improve service
delivery. They have developed a series of pathways which illustrate how this is achieved.
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The main streams of feedback sought include:
1. Service specific feedback received following discharge from the service. This is
sought from service users and/or their carers/staff depending on who has been
involved in setting and achieving the goals for intervention
2.Randomised telephone feedback for service users on active caseloads
3. Verbal feedback obtained on a voluntary basis from service users, carers and other
professionals. “Verbal” is a term loosely applied in this context, as feedback is
accepted that has been communicated effectively via any means of communication
4. Focus group feedback – Service users and patient partners are invited to comment
on aspects of service delivery to inform change
5. GP/referrer feedback – feedback is sought alongside reports to seek feedback on
our input and how we have communicated the outcome of our intervention.
Feedback received is documented by staff and in accordance with the feedback codes
(which relate to diagnosis and type of SLT input received).
The number sent compared to the number received is monitored to ascertain how
representative the feedback is of caseloads and to inform whether further changes to
methods of collection for feedback are indicated.
Every month, feedback is shared with the team at the team meeting.
The SLT manager and/or the therapist:
• Generates an action plan in response to the feedback
• Shares feedback and any action plans with the Customer Care Team
The SLT team are open to any feedback on service delivery or suggested changes to be
made at all times. When spontaneous feedback is shared, the recipient informs the person
giving feedback that this will be shared with the team and action plans made accordingly as
appropriate.
Focus groups are arranged in order to involve service users in consideration of any service
delivery issues or changes.
Feedback received is used to improve service delivery, and is recorded and processed as for
all other feedback received.
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The Continence Service in Wigan won a National Award The Wigan Continence Care Service, provided jointly by Bridgewater in partnership with
Wrightington, Wigan and Leigh NHS Foundation Trust (WWL), received the Continence Care
Team award at the inaugural National Continence Care Awards in London. The service
received the award for being “a multi-professional continence team which effectively delivers
improvements in the patient experience and quality of life”.
St Helens Health Improvement Team launches “It’s Time to Talk…”
In May 2014, the Health Improvement Team St Helens launched “it’s Time to Talk…”
campaign in St Helens.
As part of the Healthy in St Helens event, the team offered information and tips on how the
public can start a conversation with a friend, relative, colleague or neighbour. The campaign
links closely with the national Time to Change campaign, which aims to end mental health
discrimination. Since its launch in 2007, evidence shows that there has been significant
improvement in public attitudes towards mental health.
As part of the launch, the team encouraged people to make a pledge to do something small,
but meaningful for a friend whether it was a walk, a call, a text or a chat over a cuppa.
HSJ Awards Winner: Managing Long Term Conditions
The Integrated Neighbourhood teams in Wigan won the ‘Managing Long Term Conditions’
award at the national HSJ Awards 2014 in London.
The awards are the largest celebration of healthcare excellence in the UK, highlighting the
most innovative and successful people and projects in the sector.
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The creation of Wigan’s integrated neighbourhood teams has helped create more than 1,000
case management plans for the highest risk patients at Wigan’s practices since April 2013.
This has contributed significantly to a 43% drop in A&E visits and a fall of 48% in emergency
admissions. Outpatient attendance was also down by 17% by January 2014.
A standard operating procedure, dedicated clinical facilitators and admin support,
investment in new technology, patient meetings to agree care goals, and the overall simplicity
of the system were other measures behind the success.
After a review by esteemed judging panels, made up of senior and influential figures from
the health sector, Bridgewater won in recognition of its outstanding work. The judges said
“The winner is providing system change driving whole person care - a step by step approach
which is engaging along the way”.
Supporting Patients and their Families at the End of Life
Healthcare organisations across Wigan and Leigh worked together to ensure that care for
people approaching the end of life continued to be focused on meeting individual needs and
wishes in line with the Priorities of Care as outlined in the document “One Chance to get it
Right: Improving people’s experiences of care in the last few days and hours of life”.
The Priorities of Care supersede the Liverpool Care Pathway and maintain a focus on
continuing to provide compassionate care while moving away from protocols and processes.
The priorities recognise that personalised end of life care plans should be created and
communication with patients and those close to them is fundamental.
The partnership of organisations across Wigan Borough were committed to applying the five
Priorities of Care in order to ensure high quality end of life care is delivered in every
healthcare setting - hospitals, the community and hospices.
A rolling programme of education and training was implemented to ensure understanding
and full use of the priorities across the borough.
In order to meet the five priorities a plan of care was developed for those approaching the
end of life and agreed with each patient and those close to them.
Special Educational Needs and Disabilities Agenda
As a result of the Children and Families Act 2014 parents should now have a stronger voice
in determining how their children’s special needs are addressed. Our services have been
working more closely with our colleagues in the borough councils to develop child friendly
Education Health and Care Plans. This is leading services to work closely together in a
different way. In order to best meet the needs of children and families who access our
services we need to ensure we have all the skills required for working in new and integrated
ways. To do this we are reviewing all our skill mix and redesigning our services to meet the
needs of the population going forward.
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Warrington Communication Project is Commissioned on a Permanent Basis
The Children and Family Services Directorate was delighted when a needs analysis project,
focusing on the communication needs of vulnerable children with communication disorders
and autism or learning disabilities, was so successful that it has been commissioned on a
permanent basis in secondary schools in Warrington.
Paediatric speech and language therapy staff worked with teaching staff in five secondary
schools with students with autism and learning difficulties. Teaching staff were coached to
deliver specialist social skills support for these vulnerable young people. Views on outcomes
from parents and schools were extremely positive with adults saying that:
• Students talk to each other more and have fewer fallouts. There is less need for staff
interventions to sort out problems at break and lunch times.
• Students are forming more successful relationships with pupils within the mainstream
school.
• Some students are more integrated into classes and need less support. Two pupils
who had significant social interaction difficulties are now almost independent in class
and are developing mainstream friendship groups.
• Mainstream subject teachers have commented that these students are more active
learners and that their classroom behaviour is more appropriate than some of their
peers.
• They participate more in class discussions.
• One school introduced the ‘Going for Gold’ reward scheme. This rewards
achievement against their goals and around positive learning behaviour. The students
in the project are among the higher achievers for this award within their mainstream
year groups.
• Academic improvements in English are a result of improved oral language skills.
Teaching staff have been able to take the young people out on community visits, which is
unlikely to have happened before the project. In all cases staff and the public have
commented on their social skills. Students could ask for information and hold a brief and
appropriate conversation with staff at the local leisure centre, the library etc.
As a result of the success of the project it has now been offered to these schools on a
permanent basis.
Paediatric Continence Service gains Makaton accreditation
The Paediatric Continence Service in Halton and St Helens gained Makaton accreditation
and are now a certified member of the ‘Makaton friendly Scheme’. This was awarded in
recognition of the team’s efforts during the intensive training and on-going assessment of
four modules by a Makaton examiner, to ensure that people, including children, feel welcome
and able to use our services.
Makaton is a language programme using signs and symbols to help people communicate.
Makaton can take away frustration of struggling to be understood and enables individuals to
connect with other people and the world around them.
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The Family Nurse Partnership
The Family Nurse Partnership (FNP) is a free and voluntary programme for first time
expectant mothers who are under 20 years of age. The FNP has been established in Wigan
since 2011. In 2014 it was expanded to include Halton and St Helens boroughs. The
programme was signed off by the FNP National Unit and began to work with young
families from November 2014. The Warrington team was established in February 2015 and
was signed off by the FNP National Unit in March 2015.
The FNP offers intensive and structured home visiting, delivered by specially trained nurses
from early pregnancy until the child is two years old.
We know from research that a healthy pregnancy gives babies the best possible start in
life. A mothers and fathers relationship with their baby right from their start is crucial for their
future health and happiness.
The specially trained family nurse will help parents understand about pregnancy and how
mothers can care well for themselves and their babies.
Information provided will support parents to make decisions which
• Increase the chances of mums having a healthy pregnancy
• Help them to manage their labour
• Improve their child’s development
• Build a positive relationship with their baby and other people
• Help parents plan for their future
• Enable parents to make healthy lifestyle choices
• Enable parents to achieve their aspirations (such as finding a job or returning to
education)
We have received some very positive feedback from families;
Mum
• “I’m more independent and prepared for being a mum”
• “Family Nurse Partnership made the difficult times easier. I can put my child first but
still do things for myself in the future”
Dad
• “can’t wait to get stuck in, this is really helping us to develop as parents, step by step”
Gran
• “it must be working, I can see she’s changed so much”
Listening into Action (LiA)
Listening into Action (LiA) is a new and innovative way of working, aimed at:
•
•
•
Removing barriers that get in the way of providing the best care to patients and their
families
Improving the patient experience
Enabling out frontline teams to do their jobs more effectively
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Bridgewater staff know what needs to be done to improve our services, and LiA puts them at
the centre of change – using their knowledge, ideas and experience to make changes that
have a big impact.
Bridgewater’s LiA journey started in October 2014 with the Pulse Check staff survey,
designed to assess staff motivation and engagement. The results highlighted the need to
improve staff morale, so work began on the Chief Executive’s “Big Conversation” events.
Nearly 400 staff contributed to the eight events held across the boroughs and through the
intranet page.
Staff were asked to feedback on what gets in the way of them delivering the very best care
for our patients, and what changes they think would make the biggest impact. All
suggestions were documented and key themes emerged, including IT, morale and culture,
and recruitment.
A number of “quick wins” were also highlighted and acted upon, including the introduction
of teleconferencing phone lines, WiFi access at Newton Hospital, and a dedicated phone-in
session with the Director for People, Planning and Development.
The LiA Sponsor Group identified 13 key themes, and oversaw the creation of new dedicated
staff-led working groups. These groups have spread the LiA ethos throughout Bridgewater
by holding “smaller conversations” within their teams, striving to make improvements to their
work stream through to the “Pass it On” events in June 2015. Bridgewater’s Chief Executive
will continue to chair the bi-weekly Sponsor Group Meetings.
Developing our Organisational Culture
Over the past year the Trust has made a commitment to achieve a culture change across
the organisation. This is to create a culture that truly engages with and empowers our staff to
enable them to provide the highest standard of care for patients, service users and an
environment that promotes a culture of wellbeing for staff.
A series of workshops have been held with all levels of staff during the year to shape the
culture framework for the Trust. The framework will be launched in 2015/16.
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Quality, Innovation, Productivity and Prevention (QIPP)
QIPP is an approach to how services can be delivered against a backdrop of increasing
pressure on NHS budgets nationally. The QIPP approach is that through reviewing how we
currently deliver services we can find new and innovative ways of delivering a better service
at a lower cost. QIPP is also about identifying new services that will improve quality and
outcomes for patients but save money elsewhere in the NHS. This means that more money
can be spent in the community, keeping people more independent in their own homes.
Last year we described our planning for a new fracture liaison service (FLS) in Wigan. This
went live on 1st April 2014 and is already demonstrating a significant impact on the care we
provide for patients. The following table shows the performance at the end of March 2015:
Quality Standards
Performance 2014/15
1. 90% of referrals are seen within 6 weeks
96.2%
2. 100% of referrals are seen within 18 weeks
100%
3. 100% of referrals are made to the FLS within 7 days of being
seen (originating provider dependant)
100%
4. 100% of patients are followed up for medication optimisation
within one month of being assessed by the service
100%
5. 100% of patients are followed up for medication optimisation
within 12 months of being assessed by the service
Not yet available
The service has received 1347 referrals and completed 1081 contacts during the year, the
majority of whom had been referred from fracture clinic. Patients are prescribed a bone
sparing drug called bisphosphonate which helps to strengthen bone density and so prevent
fractures and lifestyle advice. The fewer the number of fractures the less demand there is on
A&E, emergency theatres and medical beds, demonstrating how an initiative in the
community improves outcomes for patients and reduces demand for hospital care.
Bridgewater also led a whole system initiative in Wigan called Integrated Neighbourhood
Teams or INTs. These are multidisciplinary teams in the community (Bridgewater,
Wrightington Wigan and Leigh, 5 Boroughs Partnership Trust, Wigan Council) who meet with
GPs to discuss and agree care plans for patients who have been frequently admitted to
hospital. By meeting in this way and sharing information, the patient’s care can be better
co-ordinated and they can be supported to remain independent in their own home. As with
the fracture liaison service patient outcomes and experience has improved as well as
creating an overall reduction in demand for hospital services. In November 2014, Integrated
Neighbourhood Teams won the prestigious HSJ Award for managing long term conditions.
During the last year Bridgewater has been working together with health and social care
partners in Wigan to develop an integrated Community Nursing and Therapies (ICNT) service
which will radically change the way services are delivered. Based around locality integrated
hubs, services will be co-located (children’s, health improvement, mental health, social care,
community and long term conditions management). The re-designed service will improve the
management of both higher risk patients (the INTs will be core to the new delivery model) but
also focus on patients who have a lower risk score to support self-management and
independence.
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Clinical Strategies
The Clinical Services Strategies set out the intentions for the delivery and development of
services over the next five years. They include what we do, why and how to ensure that our
services are in the strongest position to deliver high quality care and promote health and
wellbeing in our communities.
Internally, the Trust’s mission, core values and quality strategy were integral to the development
of the clinical strategies and support delivery of the ambitions set out in the strategies.
Externally, national and local policy guidance and commissioning intentions along with
professional and expert group guidance also informed our thinking.
The insight our frontline staff have into their work underlines the importance of their role in
clinical service development and innovation. They have the advantage of being able to
combine their practical experience of delivering services with national, professional, clinical and
policy guidance and locally determined requirements from our commissioners. The Trust has
responded strongly to staff involvement in the co-production of strategies via a range of quality
seminars held with front line staff.
Examples of the positive impact of our strategy on our population can be found throughout this
document.
Strategy Days
Two strategy days were held in 2014/15 to enable the senior management team and clinical
leaders to focus on the Trusts strategy particularly considering the five year forward view,
commissioning intentions of the CCGs and meeting the future needs of the borough
populations.
The strategy day in December 2014 focused on the five year forward view and taking stock of
where we were at that point in time Borough by Borough. The strengths, weaknesses,
opportunities and threats were mapped for each health economy. This gave the opportunity for
the challenges below to be considered specific to each boroughs local needs and context.
Workshops were held to look at some key challenges for us and to consider:
• How we may become a multi-specialty community provider
• What our role is in urgent and emergency care
• What our primary care strategy should be
Following discussion next steps and plans were agreed for each of the work groups.
The strategy day held in March 2015 was an opportunity to look at the progress of the LiA,
culture and quality improvement work programmes across the Trust, the potential barriers and
what could be done to remove them. There was opportunity to revisit the work undertaken at
the December strategy day looking at the “Five Year Forward View” and forming multi-speciality
providers and at the Trusts “Living by Our Mission” strategy and how to make it a reality .
The senior management team then looked at the challenges falling out of the discussions
above and how we could meet them by doing things differently.
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Quality Seminars
The Trust held three Quality Seminars in 2014/15. The aim of the seminars was to encourage
staff to think differently about how they work and by doing things differently continually
improve the quality of care provided.
The first seminar was held in May 2014 and an external speaker Steve Head gave a very
engaging presentation centred around everyone making a 1% difference. Staff considered
what a gold standard service would look like and then what small things they could all do to
improve the quality of care they deliver.
They were asked to consider what they could stop doing that was not adding value to the
service, patients or helping colleagues and then what could they start doing that would.
They were asked to consider how they would deliver these changes and what the milestones
would be to success.
There were some excellent suggestions from staff and each member of staff made a pledge
to make one change that would improve the quality of care they provide and agreed to
review these pledges in three months’ time. The objective was to ensure that the outcome of
the seminar were real practical changes that made a positive difference to patient care and
experience.
All the quality seminars focused on considering existing practice, processes and systems
and challenging the way we currently provide care to encourage staff to think how they could
implement both immediate small practical changes and innovative transformation to improve
quality.
Health Improvement Programmes
Throughout 2014/15, Bridgewater has provided a comprehensive range of Health
Improvement services in ALW, Halton and St Helens. These services are provided by teams
which have diverse and specialist skills, and they work in close partnership with local
communities, voluntary and third sector organisations. The teams have a remit to enable
clients to improve their own health. Using motivational interviewing techniques, the health
improvement teams support clients to stop smoking, adopt healthier eating, reduce their
alcohol intake and engage more in their local community. Clients can self-refer to the services
but they are often signposted by other health professionals such as GPs, practice nurses,
Health Care Assistants and Bridgewater partners. The pathway through the service may be
directly attributed to a health check.
The services are delivered in many venues across the boroughs including GP surgeries, LIFT
buildings, libraries, Job Centres, community centres and workplaces ensuring easy access
for service users.
Examples of how these teams improve individual health are highlighted in the ‘Be clear on
cancer’ work streams (where awareness is raised about risks of developing cancer and how
to access services and support as soon as possible if people have signs and symptoms)
and weight management work streams (where teams support people to lose weight through
improved choices about diet, exercise and cooking, as well as working on motivation and
self-esteem). The teams work in novel ways to reach out to local communities – one example
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being a drama workshop to improve awareness of mental health issues is St Helens College.
Through drama, students were made aware of their own emotions and feelings, and how to
seek support without stigma. Feedback from students included comments that ‘It made me
realise I had felt like that’ and ‘It made me want help others’. The success of the project was
far reaching, such that consideration is being given to roll this out to local schools.
Midwifery (Halton)
Halton Midwifery Service continues to be the only midwifery service nationally based within
a community trust. The service delivers the full remit of pregnancy and postnatal care and a
home birth facility. In the past year we have booked 1,576 women for care during their
pregnancy, cared for approximately 1,600 women and their babies in the postnatal period.
There were 12 successful planned home births and the service responded and provided care
to 10 un-booked home births. The service provides care 365 days per year and has an on
call facility from 5pm-9am also across 365 days.
The pilot of the digital pens and electronic women held records finished in March and the
system went live in April 2014. All women booking with the service now have their personal,
clinical and midwifery information stored within a bespoke system which links with SystmOne.
There have been some teething problems which are addressed as they arise but overall the
system has been beneficial to the service, the woman, and the capture of clinical data across
the maternity episode.
Postnatally, babies details and clinical care is also recorded electronically which adds to the
capture of quality data available for the baby from birth which can be shared with other health
professionals providing continuing care e.g. health visitors and form the basis of a lifelong
medical record for the child in question.
Alongside the internal maternity dashboard, April 2014 saw the introduction of the external
Clinical Commissioning Group ‘maternity dashboard’ into the service. The purpose of both
dashboards is to monitor clinical effectiveness, safe staffing and patient experience across
the service. Data is inputted monthly and RAG rated (red, amber, and green) so that trends
can be monitored and action plans produced. There are plans to amalgamate both
dashboards in the forthcoming year and a change will be made to the smoking data with all
women who smoke being referred to the smoking cessation service rather than the present
opt in referral. This is in line with the forthcoming care bundle for reducing stillbirths nationally.
User feedback is collected using the ‘friends and family’ criteria at the antenatal and
postnatal touch points. A service specific user questionnaire was distributed in June 2014
and we received 399 completed questionnaires over a four week period from 500 distributed.
Women were asked to answer 13 questions including two demographic questions and were
asked for comments at the end of the questionnaire.
99.74% of respondents felt:
• They had continuity of care
• The information given was delivered in a professional manner
• They had a chance to ask questions and
• That their questions were addressed satisfactorily.
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Comments such as ‘found all staff helpful and approachable’ and ‘very good professional
care very impressed’ were warmly received by the staff. The exercise will be repeated again
in June 2015.
Local Supervising Midwifery Report (Halton and St Helens Division)
The annual Local Supervising Audit was carried out in October 2014 and once again all the
standards were met. There were some recommendations from the visit which have been
incorporated into an action plan which is reviewed at the six weekly supervisor of midwife
meetings and both the plan and the progress will be presented at the next audit visit in
November 2015.
Alongside the trust mandatory training, midwives must complete specific midwifery updates
on a yearly basis and this training is delivered within the service with input from transfusion
services and midwifery lectures at Edge Hill. A bespoke community based emergency skills
and drills package is accessed annually by each midwife within the service to maintain
competency in emergency situations.
Community Dental
The Community Dental Service (CDS) in Bridgewater is commissioned to provide a range of
dental care in Greater Manchester, Merseyside and Cheshire as well as some public health
activity in conjunction with a number of local authorities. The key performance indicator
dictates that 95% of referrals to the service are seen within 20 working days. The service
continues to meet this target.
One of the key roles of the CDS is to provide dental care for people with severe disabilities.
Over the past year the CDS has prioritised gaining feedback from patients with disabilities
and their carers in order to provide a dental service which meets their specific needs. The
CDS now has a member of staff who has volunteered to be a ‘Disability Champion’ in each
area. They are tasked with making contact with local disability groups to seek their views on
what the ideal dental service for people with disabilities should look like.
As a result of the information gained by the Disability Champions sensory toys have been
purchased for children to play with in the waiting room and projectors to project images onto
the ceiling to distract patients during treatment. Large changing mats are now available in all
dental clinics for patients who require them.
Feedback from carers of patients with autism has resulted in staff accessing an e-learning
package from the National Autistic Society and a presentation about the effects of autism on
dental health and dental care is being rolled out to all staff. Visual communication aids have
been developed to assist communication between patients who have autism and the dental
staff.
Feedback from dental network staff revealed they needed more training on general aspects
of disability. Training sessions on person centred care for people with disabilities are now
being rolled out to dental staff.
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Walk-in Centres
The Department of Health‘s (DH) Operating Framework sets out the national clinical quality
indicators for Accident and Emergency Departments (A&E) including walk-in centres.
The Trust has three walk-in centres in Leigh, St Helens and Widnes which provide treatments
for minor ailments.
Walk In Centre
Indicator
Target
BW
Leigh
St Helens
Widnes
Percentage of patients seen in less than 4
hours
<=95%
99.77%
99.56%
99.91%
99.76%
Time to treatment decision (median value)
<=60 mins
00:19:34
00:19:26
00:20:44
00:18:02
Unplanned re-attendance %
<=5%
0.2%
0.7%
0.0%
0.1%
Left without being seen %
<=5%
0.7%
0.3%
0.7%
1.1%
The Trust and three centres have achieved their targets throughout 2014/15.
Out of Hours
The Out of Hours Services provide medical assistance by offering telephone advice from
GPs and from nurses along with face to face consultations either at home or in a primary
care centre. The Trust has two Out of Hours services, one in Wigan and one in Warrington.
From 1st January 2005, all providers of GP Out of Hours (OOH) Services are required to
comply with the National Quality Requirements (NQR) first published in October 2004.
The services report quality standards dependent on their agreed service specification and
performance.
This year’s data shows an improvement in compliance for both services.
It should be noted, that due to the low numbers reported in some quality requirements
individual breaches can make a significant difference to compliance levels.
Actions are in place to further strengthen performance and create greater resilience within
the service. The service is constantly reviewing and amending the service model to better
meet demand performance and quality to improve the patient experience.
Out of Hours Services are required to be compliant against a set of national targets. The
Trust has gradually improved its performance against the targets throughout 2014/15,
however the cumulative position is described in the table below:
83
Quality Requirements description
QR01 Regularly reporting of Quality Standards
QR02 Clinical details sent before 8;00
QR03 Patients with defined needs
QR4
Clinical Audit complete
QR5
Patient Experience
QR8a
Engaged Calls
QR8b Abandoned Calls
Targets
Wigan
Warrington
Compliant
Compliant
Compliant
100%
97.91%
96.18%
Compliant
N/A
Compliant
100%
N/A
100%
1%
N/A
Compliant
0.10%
N/A
0.00%
5%
N/A
2.30%
QR8c
Answered with 50 seconds
100%
N/A
94.76%
QR9a
Emergency Care Requiring Ambulance
100%
N/A
100%
100%
N/A
89.83%
100%
N/A
90.28%
QR12a PCC Emergency Appointment within 60 minutes
100%
100%
100%
QR12b PCC Urgent appointment within 120 minutes
100%
93.02%
91.38%
QR12c PCC Routine appointment within 360 minutes
100%
99.42%
98.43%
QR12a Visit Emergency appointment within 60 minutes
100%
N/A
90.00%
QR12b Visit Urgent appointment within 120 minutes
100%
89.51%
88.59%
QR12c Visit Routine appointment within 360 minutes
100%
97.85%
96.26%
QR12a Telephone Emergency appointment within 60 minutes
100%
98.80%
N/A
QR12b Telephone Urgent appointment within 120 minutes
100%
99.41%
N/A
QR12c Telephone Routine appointment within 360 minutes
100%
99.94%
N/A
Compliant
Compliant
Compliant
QR9b Urgent Care requiring call within 20 minutes
QR9c
Routine Care requiring call within 60 minutes
QR13 Interpretation Services within 15 minutes of initial contact
Compliant
Non Compliant
Partially Compliant
Not applicable
Waiting Times
The Trust monitors and reports on the length of time between a patient’s referral to one of our
services and when the treatment is received by the patient.
Waiting Times - Consultant Led Services
Consultant-led services are those where a consultant retains overall responsibility for the
clinical care of the patient.
The completed Referral to Treatment (RTT) pathway is a true indicator of the length of time
between referral and the start of treatment.
84
Bridgewater Consultant-led Services
Referral to Treatment Times
April 2014 to March 2015
Number of waiters
1000
900
800
700
600
500
400
300
200
100
0
Apr-14 May-14 Jun-14 Jul-14
Aug-13 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar15
< 11 weeks
11-17 weeks
> 18 weeks
At the end of 2014/15 the Trust had a total of 782 patients waiting for consultant-led services.
Waiting Times - All Services
The Trust measures the time that has elapsed between receipt of referral to the start of
treatment and applies the national target of 18 weeks to all its services. Below are patient
waiting times reported at the end of each month for all Bridgewater services (2014/15).
All Bridgewater Services with Waiting Lists
Waiting Times April 2014 to March 2015
Number of waiters
14000
12000
10000
8000
6000
4000
2000
0
Apr-14 May-14
Jun-14 Jul-14
< 11 weeks
Aug-14 Sep-14 Oct-14
11 - 17 weeks
Nov-14 Dec-14
> 18 weeks
Jan-15 Feb-15 Mar15
At the end of 2014/15 the Trust had a total of 10,769 patients waiting for all services. Of these
9,827 (91.25%) were waiting under 11 weeks.
85
Cancer Services
The Trust delivers community based cancer services to patients living in the Warrington area
which is commissioned by Warrington CCG.
The table below demonstrates that the Trust has been meeting and overachieving against the
Referral to Treatment and cancer targets throughout 2014/15
Waiting Times
All cancers: 31-day wait for second or subsequent treatment (Surgery)
All Cancers: 62-day wait for first treatment (From urgent GP referral to
treatment)
All cancers: 31-day wait (From diagnosis to first treatment)
All cancers: 2 weeks wait from referrals to date first seen
Thresholds
94%
Full Year 14/15
100.00%
Achieved?
P
85%
98.65%
P
96%
93%
98.36%
99.52%
P
P
Compliance against Targets
Referral To Treatment time is the length of time between a patient’s referral to one of our
services to the start of their treatment.
The NHS Constitution gives patients the right to:
• Start your consultant led treatment within a maximum of 18 weeks from referral for
non-urgent conditions
• The Trust also aspires to meeting the 18 week pledge for all other services
• Be seen by a cancer specialist within a maximum of two weeks from GP referral for
urgent referrals where cancer is suspected
• Start your AHP led treatment within a maximum of 18 weeks from referral for
non-urgent conditions.
The Trust achieved all its quarterly monitored national targets for waiting times during
2014/15.
Performance against Referral to Treatment (RTT) waiting time targets
As part of the national requirements the Trust is required to report on the length of time
between referral to a Consultant-Led service and the start of treatment being received. The
following table demonstrates our compliance against the 18 week RTT target of 95% for
completed pathways.
Consultant-Led Services
Referral To Treatment
(completed pathways)
Referral to treatment 18 week compliance (95th percentile) Full year
Referral to treatment 18 week compliance (% under 18 weeks) Full year
Thresholds
Full Year 14/15
Achieved?
<18.3
95%
15.83
97.0%
P
Within 2014/15 the Trust met and exceeded the 95% threshold set.
86
Foundation Trust Application
The Trust has now completed Monitor’s foundation trust (FT) application process. Following
the findings of the Care Quality Commission’s (CQC) inspection carried out in February 2014,
the Trust was able to progress to the final stage of the FT application process, and
re-engaged with Monitor in June 2014.
During this final stage, Monitor’s assessment team visited the Trust to conduct on-site
interviews with the Board of Directors, clinical staff, our Governors and partner agencies.
Following this rigorous process, the Trust Board met with Monitor’s Board in London on 9th
September 2014 and on 1st November, Bridgewater was one of the first two community
trusts to be awarded an FT licence.
Monitor Regulation
Now that the Trust has attained FT status, it is subject to the routine annual planning and
reporting requirements set out by Monitor, as part of their on-going regulation of foundation
trusts.
Each year, Monitor sets out the annual planning and reporting cycle that details the actions
and submissions that the Trust must make to maintain its FT licence. The required
submissions include detailed information on finance and activity, contracts and performance,
and a comprehensive operational plan that sets out the Trusts intentions for the coming
financial year.
Performance against the Risk Assessment Framework is set out below.
Risk Assessment
Framework 2014/15
Q1
Q2
Q3
Q4
n/a
n/a
4
4
n/a
n/a
Green
Green
Continuity of Service Rating
Governance Rating
Continuity of Service Rating score of 4 - Monitor will generally take no action beyond
continuing to monitor the licence holder.
Governance Rating of Green – No governance concern is evident or where Monitor are not
currently undertaking a formal investigation.
87
The Trust has a Council of Governors which consists of both elected and appointed
governors. Throughout this first year of operation as a foundation trust, the Council of
Governors’ role has been developing. Governors have provided a valuable input to quality
visits to a number of services this year, bringing their ‘lay’ perspective to bear in improving
service delivery. They have undertaken considerable outreach to local communities,
increasing the membership and promoting the work of the Trust. More formally, the
governors were engaged in the stakeholders sessions as part of the appointment of a new
Chief Executive Officer, and have commenced the process of recruiting new non-executive
directors.
The Trust was already operating a Council of Governors in shadow form, following elections
in September 2013, in preparation for becoming a foundation trust. Following authorisation,
formal Council of Governor meetings were held in November 2014, December 2014 and
March 2015.
The Council of Governors comprises a total of 33 Governor seats, of which 18 are elected
Public Governors, nine are elected Staff Governors and six are appointed Partner Governors.
The Council is chaired by the Trust’s Chairman and the Lead Governor.
Monitoring the Quality of Services across Bridgewater
Board and Sub-Committees
The Board and Sub-Committee structure of the Trust is illustrated below.
Audit
Committee
Investment
Committee
Quality and
Safety
Committee
BOARD
Trust
Effieciency
Assurance
Committee
Nominations
and
Renumerations
Local
Negotiating
Committee
During 2014/15 the Quality Management Group, as a sub-group of the Quality and Safety
Committee (QSC), was established as an operational group to facilitate discussion on all
quality related issues e.g. incidents, risks, CQC compliance, new national initiatives e.g. Sign
up to Safety and presentations from the directorates regarding key service delivery and
staffing priorities. This group includes key senior managers to ensure that any identified
barriers to the provision of quality care are addressed in a timely manner and escalated to
the QSC as appropriate. This group has enabled the Trust to proactively manage and
challenge the quality agenda.
88
Quality Impact Assessment Process
Quality Impact Assessments (QIA) are carried out to review all cost improvement programme
(CIP) schemes, to ensure there are no negative impacts to the quality of services.
The QIA panel has been established to oversee the Trust’s QIA process. It provides
assurance that there is a robust QIA process for all CIP schemes. It reports internally to both
the Quality and Safety Committee quarterly and the Trust Efficiency Assurance Committee
(TEAC) on a monthly basis and externally to the Clinical Commissioning Groups.
Action taken to Address Francis Report Recommendations
The Trust undertook an assessment of the 290 recommendations in the Francis 2 report
which were then categorised into 26 objectives for the Trust in 2014/15. The Trust has
monitored this action plan with regular updates to the Board and the four Clinical
Commissioning Groups. This is now normal business of the Trust and the Quality Strategy
will provide further framework to embed quality into the Trust culture.
Action taken to Address Freedom to Speak Up Recommendations
The Trust has undertaken a gap analysis against the Freedom to Speak Up – Review of
whistleblowing in the NHS, which during 2015/16 will be developed into an action plan and
will be monitored by the Quality and Safety Committee.
Sign up to Safety
Sign up to Safety is designed to help realise the ambition of making the NHS the safest
healthcare system in the world by creating a system devoted to continuous learning and
improvement. This ambition is bigger than any individual or organisation and achieving it
requires us all to unite behind this common purpose. We need to give patients confidence
that we are doing all we can to ensure that the care they receive will be safe and effective at
all times.
Sign up to Safety aims to deliver harm free care for every patient, every time, everywhere. It
champions openness and honesty and supports everyone to improve the safety of patients.
Patient safety is a top priority at Bridgewater Community Healthcare Foundation Trust. We
have signed up to the ‘Sign up to Safety’ initiative, which is designed to help realise the
ambition of making the NHS the safest healthcare system in the world. We have developed
our patient safety improvement plan for 2015/16 based on the Sign up to Safety actions and
we have committed to the five Sign up to Safety pledges (please see Priorities for
Improvement in 2015/16 section for further details).
Open and Honest Care (previously known as the
Transparency Project)
From April 2014 the Trust was the only Community Trust to publish Open and Honest data.
The data published relates to pressure ulcer data as collected as part of the NHS Safety
Thermometer. We also publish data relating to staff and patient experience, including patient
stories submitted to the Board and lessons learnt by the Trust. It is envisaged that it will
89
support patient choice, enhance staff knowledge and lead to changes in both clinical
practice and organisational culture which is seen as fundamental to good patient care.
The Trust has worked with the national team to further develop the work and look at how
further areas of care can be reported on.
NHS Safety Thermometer
The NHS Safety Thermometer is a national improvement tool for measuring, monitoring
and analysing patient care and “harm free” care. It provides a quick and simple method for
surveying patient harms and analysing results so that we can measure and monitor local
improvement and harm free care over time.
The Trust has been compliant with submission of this data during 2014/15.
Bridgewater Sample Size
This table illustrates the size of the population that contributed to the point prevalence
monthly monitoring.
Bridgewater
Sample Size
March April May
-14
-14 -14
June
-14
Jul
-14
Aug
-14
Sep
-14
Oct
-14
Nov
-14
Dec
-14
Jan
-15
Feb
-15
Mar
-15
1025 940 981 1197 951 970 1134 1044 981 1085 966 1050 964
Percentage of Harms (New)
This table demonstrates that for 11 months of 2014/15, the Trust reported a below national
average position for new harm caused by the Trust during a patient’s episode of care.
Percentage
of harms
(New)
Mar
-14
Apr
-14
May
-14
Jun
-14
Jul
-14
Aug
-14
Sep
-14
Oct
-14
Nov
-14
Dec
-14
Jan
-15
Feb
-15
Mar
-15
National
2.57%
2.53%
2.51%
2.46%
2.34%
2.47%
2.42%
2.42%
2.32%
2.26%
2.40%
2.36%
2.32%
Bridgewater
Community
NHS
Foundation
TrustTrust
3.02%
2.02%
1.12%
2.34%
0.95%
1.96%
1.94%
1.15%
1.73%
2.12%
1.66%
1.81%
1.04%
Percentage of Harm Free
This table demonstrates that for 12 months of 2014/15, the Trust reported an above national
average position for patients who had received harm free care during their episode of care.
Percentage
of harms
(New)
Mar
-14
Apr
-14
May
-14
Jun
-14
Jul
-14
Aug
-14
Sep
-14
Oct
-14
Nov
-14
Dec
-14
Jan
-15
Feb
-15
Mar
-15
National
93.62%
93.56%
93.50%
93.59%
93.82%
93.66%
93.72%
93.87%
93.88%
94.07%
93.82%
93.72%
93.96%
Bridgewater
Community
NHS
Foundation
TrustTrust
94.44%
95.21%
96.02%
95.82%
96.42%
94.95%
95.41%
96.46%
95.11%
96.13%
94.51%
94.95%
95.02%
90
Internal Audit
During the past year our internal auditors (Mersey Internal Audit Agency) have undertaken a
series of reviews of various aspects of services. Below is a table indicating the reviews
undertaken and the assurance levels given.
High Assurance - Some low impact control weaknesses found which, if addressed would
improve overall control. However, these weaknesses do not affect key controls and are
unlikely to impair the achievement of the objectives of the system.
Significant Assurance - There are some weaknesses in the design and/or operation of
controls which could impair the achievement of the objectives of the system, function or
process. However, either their impact would be minimal or they would be unlikely to occur.
Limited Assurance - There are weaknesses in the design and / or operation of controls
which could have a significant impact on the achievement of the key system, function or
process objectives but should not have a significant impact on the achievement of
organisational objectives.
REVIEW TITLE
ASSURANCE LEVEL
Emergency Preparedness Review
Objective: To review and evaluate the arrangements in place within the Trust in relation to
Emergency Preparedness systems and procedures.
Significant
General Ledger
Objective: The financial ledger records all financial transactions of the organisation and
ensures their completeness and integrity, with the aim of providing the basic data from which
management accounts, financial accounts and statutory returns can be prepared.
Significant
Income & Debtors
Objective: All income due to the organisation is properly identified, collected and accounted
for under management control and management receives timely and adequate information to
control this.
Significant
Non Pay Expenditure
Objective: All goods and services are ordered promptly by authorised officers, are available
when required are of an appropriate quality, and the correct payment is made to the
correct payee at the most appropriate time and is properly accounted for in the organisation’s
records. Significant
Treasury Management
Objective: Ensuring that the financial stability of the organisation is attained and then
constantly monitored and maintained to enable the organisation to meet its business plan.
Significant
SystmOne & IG Governance Arrangements
Objective: To provide an opinion on the adequacy of the governance framework implemented
around the SystmOne application with reference to the best practice standards such as the
NHS Information Governance Toolkit.
Significant
Recruitment Processes Follow Up
Objective: To provide an update against the position reported to the April 2014 Audit
Committee meeting on the progress of recommendations made in respect of the 2013/14
review of Recruitment Processes.
Significant
Serious Untoward Incidents (SUIs) Follow Up
Objective: To provide an update on the progress of implementation of recommendations
made in the 2013/14 SUI review and provide an analysis of the level of agreement with the
recommendations made. Significant
91
REVIEW TITLE
ASSURANCE LEVEL
New Domain Review
Objective: To provide an opinion on the design, effectiveness and coverage of the
arrangements in place to protect and manage the new Microsoft Domain and the system, data
and user resources under its control. Significant
Information Governance (IG) Toolkit
Objective: To provide an opinion on the adequacy of policies, systems and operational
activities to complete, approve and submit the IG Toolkit scores. We also provided an opinion
on the validity of the scores based on the evidence available.
Significant
Safeguarding Follow Up Review
Objective: To provide an update against the position reported to the February 2015 Audit
Committee meeting on the progress of recommendations made in respect of the 2014/15
review of Safeguarding. Significant
Telephony (VOIP) Review
Objective: To provide an assessment of the effectiveness of the control framework being
exercised by management over the telephone systems and highlight improvements where
appropriate. Limited
Safeguarding Review (Superseded by Follow Up)
Objective: To The overall objective of the review was to assess the systems and processes in
place across the organisation to ensure compliance with safeguarding statutory requirements
and guidance.
Limited
Data Consistency Phase I Review
Objective: To ensure that the Trust has robust systems and processes in place for collecting
and recording activity data to support the complete and accurate reporting of activity data to
Trust Board in accordance with national definitions and requirements. Limited
Network Infrastructure Review
Objective: To provide an assessment of the risks associated with the adequacy and
effectiveness of the network infrastructure (such as distributed cabling, switches, routers,
firewalls and monitoring tools) and associated control framework, that provides responsive
and resilient connectivity between users, key systems and data storage across the Trust’s
managed estate as well as external connections.
Limited
Financial Systems Technical Security Review
Objective: To provide an assessment on the effectiveness of the technical security control
framework being exercised by management over Financial Systems including Excel
spreadsheets created in-house and highlighting opportunities for improvement, where
appropriate.
Limited
School Nursing Service Review
Objective: To provide an opinion on the controls and systems in place at a local level, focusing upon the School Nursing Service.
Limited
20 Working Day Dental Target
Objective: To ensure there are adequate systems and controls in place to deliver the 20 day
dental target.
Limited
Specialised Services Governance Arrangements Review
Objective: To provide assurance that the governance arrangements in place and operating
within the Specialised Services directorate are in line with the Trust’s accountability
framework.
ESR (HR / Payroll) Review
Objective: To provide an assessment of the effectiveness of the systems of control operating
at the Trust to ensure that only employees of the organisation are paid, and only for work that
they perform on behalf of the organisation.
92
Limited
Limited
Detailed action plans have been developed in response to all recommendations from the
MIAA reports, regardless of the overall level of assurance, and will be monitored by the Audit
Committee and the Quality and Safety Committee with follow up visits planned by MIAA
during 2015/16 to receive updates and assurance that these have been addressed.
The Audit Committee was in receipt of full reports and progress reports on all of the audits
and recommendations during 2014/15.
Stakeholder Involvement in the Development of our Quality Account
Opportunity to Shape the Content of our Quality Account
Prior to our quality account being drafted our Chief Executive wrote to our Clinical
Commissioning Group’s and Local Authorities requesting their input into the content of the
account. A number of suggestions were received regarding content and our 2015/16 quality
improvement priorities which have been addressed during the development of the account.
Stakeholder feedback
We sent out our draft Quality Account to our stakeholders inviting them to comment on
whether or not they considered the document to be accurate in relation to services provided.
All of the responses have been included in our account.
Wigan
Healthwatch Wigan Stakeholder Feedback
Healthwatch Wigan (HWW) welcome this Quality Account for 2014/15 and would like to
congratulate the Trust and all the staff at Bridgewater on becoming one of only two
Community Trusts to achieve Foundation status. HWW would also like to acknowledge the
hard work of staff at all levels of the Trust in maintaining and, in many areas, improving the
services delivered to the people of Wigan.
HWW recognises the work done by the Board in the past year to improve staff engagement
and improve staff morale and we look forward to seeing this work continuing to enable further
improvement to the services being delivered by Bridgewater. HWW would like to encourage
the Trust to continue to use ‘Patient Stories’ as a way of illustrating the patient experience
to the Board but would like to see a negative story used occasionally, one where perhaps
services were not up to the standards required by the Trust. We feel that these will help the
Board to understand the patient experience even better.
HWW would like to see included in the 1st Priority a statement about the Trust having a ’no
blame culture’ in order for staff to feel able to report all incidents and admit mistakes
regardless of fault and to learn from them.
HWW would like to see some explanation in the report of some of the results recorded e.g.:
• Why the Breast feeding rates at 6-8 weeks have fallen
93
•
•
Why the take up of Personal Development Reviews amongst Corporate Staff was only 50%
Whilst HWW recognises the work the Trust is doing to stop patients going to A&E by the introduction of the Northwest Ambulance Service (NWAS) Pathfinder Service which has diverted patients to the Leigh Walk-in Centre, we would like to see a breakdown of patient outcomes when using the Out of Hours Service in Wigan.
HWW would like to see a report included in the account about the work, if any, the Trust is
doing with the Voluntary Sector in Wigan to enhance the patient experience.
Finally HWW would like to congratulate the Wigan Continence Care Service on receiving the
Continence Care Team award at the inaugural National Continence Care Awards in London
and the Wigan District Nurse Liaison Team on the work they are doing to improve the
‘discharge experience’ for patients at the Royal Albert Edward Infirmary.
Martin Broom
Director, Healthwatch Wigan
94
Wigan Borough Clinical Commissioning Group Response to Bridgewater
Community Healthcare NHS Foundation Trust Quality Account 2014/2015
Wigan Borough Clinical Commissioning Group (the CCG) appreciates the opportunity to
comment on the Annual Quality Account for Bridgewater Community Healthcare NHS
Foundation Trust.
Firstly the CCG would like to congratulate the Trust on being one of the first two NHS
Community Trusts to have been awarded Foundation Trust status. The CCG also
welcomes and recognises the progress that the Trust has made in respect of their
2014/2015 quality priorities.
Notable successes have included for example; the work undertaken on developing the
‘Open and Honest Care’ programme with Patient Stories presented to the Trust Board on
a monthly basis and the related work to improve the accuracy of Pressure Ulcer reporting
across the Trust. The CCG also recognises the improvement in the Patient Experience
scores from 98% at the end of 2013/2014 to 99% at 2014/2015. However there are areas
where further improvement is required; and the CCG requests that the Trust seeks to
improve its governance arrangements in relation to the investigation and learning from
Serious Incidents (SIs). In addition the Trust should also actively seek to improve their
reporting of Patient Safety Incidents (PSIs) with no or low harm as a consequence to the
National Reporting and Learning System (NHS NRLS). This will assist to provide
assurance that the Trust is a learning organisation.
The quality priorities for 2015/2016 inclusive of engagement with; the National Campaign
‘Sign up to Safety’ and the NHS Safety Thermometer Improvements in Care will assist to
shape and support the future improvements to improve the quality, safety and experience
of the care provided by the Trust services.
The CCG will also support the Trust to deliver safer, effective and caring healthcare
through the agreed Commissioning for Quality and Innovation (CQUIN) Schemes for
2015/2016 to incentivise quality improvements for example; in Frail Elderly Care; Out of
Hours Antibiotic Stewardship and Patient Safety.
The CCG looks forward to continuing to work with the Trust during the coming year, to
build on the progress made and to provide continued support to the planned initiatives that
will seek to improve the quality of care and outcomes for the resident population of the
Wigan Borough.
Dr Tim Dalton, Chairman, Wigan Borough Clinical Commissioning Group
May 2015
95
96
Kate Fallon
Chief Executive
Bridgewater Community Healthcare NHS Trust
Bevan House
Smithy Brook Road
Pemberton
Wigan, WN3 6PR
Our Ref
EST
If you telephone Emma Sutton-Thompson
please ask for
Your ref
th
Date
20 May 2015
E-mail address
Emma.Sutton-Thompson
@halton.gov.uk
Dear Kate,
Our Ref
EST
Kate Fallon
Quality
Accounts 2015
Chief Executive
If you telephone Emma Sutton-Thompson
Bridgewater Community Healthcare NHS Trust please ask for
Further to receiving a copy of your draft Quality Accounts
and the Joint Quality Accounts
Bevan House
event held on 13th May that your colleague Dot Keates
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20 May
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the2015
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Wigan, WN3 6PR
areas:
E-mail address Emma.Sutton-Thompson
@halton.gov.uk
During the year 2014/15 the Trust identified a number of priorities to be achieved during
this year. The Board were pleased to note that the majority of the targets for this year
were achieved which is extremely good. The three areas that were not achieved, have
Dearput
Kate,
been
against the priorities for this year and the Board look forward to also seeing
improvements in these quality areas.
Quality Accounts 2015
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Board
are pleased
to see
theandaction
plan that
hasparticularly
been implemented
to make
areas:
improvements
in this area, in particular the professionals forum, monthly team brief and
“you said, we did” cascades.
During the year 2014/15 the Trust identified a number of priorities to be achieved during
this
year.areThe
Boardtowere
to note
that the majority
of the
targets
for this year
The
Board
pleased
note pleased
the additional
Improvement
Priorities
for 2015
– 2016:
were achieved which is extremely good. The three areas that were not achieved, have
been put against the priorities for this year and the Board look forward to also seeing
improvements
these quality
areas.noted that the Trust aims to deliver harm free care
 ‘Sign up toinSafety’
– the Board
for every patient, every time, everywhere and to champion openness and honesty
The to
Board
noted
the of
staff
survey on recommending the Trust as a place to work or
improve
thethat
safety
patients.
receive
treatment
was
below
the
national
but slightly
improved on the previous
 Improvement in the handling of
seriousaverage,
and untoward
incidents
year. The Board understand that the large organisational changes that have taken place
 NHS Safety Thermometer improvements in care – the Board are particularly
will affect people’s morale and perceptions, and hopefully this will improve over time. The
interested to see a reduction in avoidable pressure ulcers in the coming year.
Board are pleased to see the action plan that has been implemented to make
improvements
in this area, in particular the professionals forum, monthly team brief and
Communities
Directorate
“you
said,
we
did”
cascades.
Runcorn Town Hall, Heath
Road, Runcorn, Cheshire WA7 5TD
The Board note that the
priorities for next year were all centred around safety and felt that
Tel: 0151 907 8300
other areas to be considered were effectiveness and lessons learnt.
The Board are pleased to note the additional Improvement Priorities for 2015 – 2016:
The Board would like to thank Bridgewater Community Healthcare NHS Trust for the
opportunity to comment on these Quality Accounts.
 ‘Sign up to Safety’ – the Board noted that the Trust aims to deliver harm free care
for every patient, every time, everywhere and to champion openness and honesty
Yours sincerely,
to improve the safety of patients.
 Improvement in the handling of serious and untoward incidents
Councillor Joan Lowe
Communities Directorate
Chair,
Health Policy and Performance Board
Runcorn Town Hall, Heath Road, Runcorn, Cheshire WA7 5TD
Tel: 0151 907 8300
97
Esther Kirby
Director of Nursing and Quality
Bridgewater Community NHS Foundation Trust
28th May 2015
Re: QA Bridgewater 14-15 JS
Dear Esther
First Floor
Runcorn Town Hall
Heath Road
Many thanks for the submission of the Quality Account for 2014-2015 and for the presentation
to
Runcorn
local stakeholders on 13th May 2015. This letter provides the response from NHS Halton Clinical
Cheshire
Commissioning Group to the Quality Account 2014-2015.
WA7 5TD
Re Quality Account 2014-2015
NHS Halton CCG understands the pressures and challenges for trust and the local
health
economy
Tel:
01928
593479
in the last year and would like to congratulate and thanks the Trust for the level
of
partnership
www.haltonccg.nhs.uk
working and support with NHS Halton CCG in this year in relation to the Urgent Care centre
developments. We also note the excellent collaborative work with your staff and managers in relation
to the review
Esther
Kirby of community nursing services in Halton and the support given by both your staff and
the localofmanager
theQuality
development of a new specification for these services for 2015-2016. The
Director
Nursing in
and
work
has
enabled
a
high
levelFoundation
of engagement
Bridgewater Community NHS
Trustwith your staff locally and has without doubt enabled
greater integration across the health economy in particular with General Practice and Local authority
social care.
28th May 2015
As you are aware NHS Halton CCG worked closely during 2014-2015 with the co commissioners
NHS
StBridgewater
Helen CCG 14-15
for Contracting
and Quality arrangements through which all indicators and
Re:
QA
JS
First Floor
CQUINs schemes were reviewed and monitored. The arrangements for 2015/2016Runcorn
contractTown
year Hall
will
be slightly
links
Dear
Estherdifferent with Halton leading on its own contract but we will continue to have close
Heath
Road
with other commissioners of your services in an effort to standardise expectations and ways of
Runcorn
workings.
year the
trust has made excellent progress in the delivery of quality improvements
Re
Quality This
Account
2014-2015
Cheshire
with some excellent work in relation to improvements in pressure ulcer prevention and management
WA7 5TD
whichthanks
are now
fully embedded
the trust.
Many
forbeing
the submission
of theinQuality
Account for 2014-2015 and for the presentation to
Clinical
local stakeholders on 13th May 2015. This letter provides the response from NHS Halton
Tel: 01928
593479
NHS Halton CCG
would
to congratulate
trust on the hard work of its staff
and their
Commissioning
Group
to like
the Quality
Accountthe
2014-2015.
www.haltonccg.nhs.uk
commitment to the care of the people of Halton. In this year we have seen significant improvements
in integrated
care to
frail elderlythe
patients,
those
with
long termfor
conditions
witheconomy
complex
NHS
Halton CCG
understands
pressures
and
challenges
trust andand
the children
local health
inneeds
the last
year are
andlooked
would after
like tothrough
congratulate
and thanks
the Trust The
for the
level of from
partnership
or who
local CQUIN
programmes.
outcomes
these
working
and support
withexcellent
NHS Halton
CCGstaff
in this
year
in relation
Urgent
Care centre in care
programmes
has been
and your
have
worked
hard to
to the
deliver
the improvements
developments.
We also notefor
thepatients
excellent
collaborative work with your staff and managers in relation
planning and management
locally.
to the review of community nursing services in Halton and the support given by both your staff and
the local manager in the development of a new specification for these services for 2015-2016. The
work
enabled
high level
engagementthe
with
your staff locally
and has without
doubt enabled
NHShas
Halton
CCG awould
like toofcongratulate
organisation
on achievement
of foundation
trust
greater
integration
thewe
health
economy
particular
with General
Practice and Local authority
status the
processacross
for which
understand
is in
both
challenging
and robust.
social care.
As
youHalton
are aware
Halton the
CCG
worked closely
during 2014-2015
with the
cobut
commissioners
NHS
CCGNHS
recognises
challenges
for all providers
in the coming
year
we look forward
NHS
St Helen
for Contracting
and Quality
arrangements
through
which all
and and
to working
withCCG
the Trust
during 2015-2016
to deliver
continued
improvement
in indicators
service quality
CQUINs
schemes were
reviewed
and
monitored.
Theasarrangements
for 2015/2016
contract
year
will
patient experience
and also
on the
partnership
work
we move forward
with our One
Halton
model
be
of slightly
service different
delivery. with Halton leading on its own contract but we will continue to have close links
with other commissioners of your services in an effort to standardise expectations and ways of
workings.
This year the trust has made excellent progress in the delivery of quality improvements
Yours sincerely
with some excellent work in relation to improvements in pressure ulcer prevention and management
which are now being fully embedded in the trust.
NHS Halton CCG would like to congratulate the trust on the hard work of its staff and their
commitment to the care of the people of Halton. In this year we have seen significant improvements
in integrated care to frail elderly patients, those with long term conditions and children with complex
Jan Snoddon
Chief Nurse/Quality Lead
NHS Halton CCG
Email [email protected]
98
Public Health Comments on Quality Accounts – May 2015
Bridgewater

Breastfeeding- More needs to be done across Halton to improve breastfeeding rates.
It was disappointing to note that the 6-8 week breastfeeding rates had got worse
since the previous year. However, it is encouraging to note that the Trust will continue
to focus on this issue over the coming year.

Dementia- Good to see that dementia targets for 14/15 were met.

Encouraging to note that falls management will form part of Quality Priority 3 for
2015/16. Halton has identified reducing the number of falls in the over 65s as part of
its Health and Wellbeing Strategy given the high rates of falls locally.

Health Inequalities and Inclusion Team- It is encouraging to note that the trust is
continuing to work on the issue of health inequalities locally. Given the increasing
health inequalities issue it is important to ensure that we continue to monitor services
to ensure they are accessible to all.

Encouraged to note the work that continues within the trust on Healthcare Acquired
Infections and the positive results this has achieved. It is also positive to note the
work that is continuing on outbreak control and steps that have been taken by the
Trust on Ebola.

Influenza vaccination for staff- it was disappointing to see that Halton had the lowest
vaccine uptake across Trust areas (45%). This is some way off the recommended
target of 75% set by the Department of Health. It would be good to see improvement
strategies in place to address this.

NICE Guidance Compliance- The report notes that in 2014/15, 25 pieces of NICE
guidance were published, however, the Trust is only fully compliant on 13. We do
however accept that action plans are in place to increase full compliance in all areas.

Audit of Growth and Nutrition Service- Whilst it is encouraging to note the decrease in
the number of children in the extreme obese category, the results show the need to
continue to focus on this important area, especially since Halton suffers from
particularly challenging rates of childhood obesity.

Childhood Immunisations- Whilst it is encouraging to see that vaccine uptake remains
high in Halton, there has been a slight reduction in a number of areas. Most of these
are very small, however, MMR uptake in 2014/15 has reduced by 2.5% from the
previous year. Whilst this still represents a modest reduction, it is still an area that
needs to be monitored to ensure it does not decrease further. Similarly, the uptake for
the Pneumococcal booster also reduced by 2.2% since last year.
Public and Environmental Health Department
Policy & Resources Directorate
Runcorn Town Hall, Heath Road, Runcorn, Cheshire, WA7 5TD
www.halton.gov.uk
99
Esther Kirby
Executive Nurse
Bevan House,
17 Beecham Court,
Smithy Brook Road,
Pemberton,
Wigan.
WN3 6PR.
Dear Esther
 01925 843636
Re:
Quality
Account
2014-2015
Please
Ask
For: John
Wharton
Arpley House
110 Birchwood Boulevard
E-mail: [email protected]
25 843636
Many thanks for the submission of the Quality Account for 2014-2015, Arpley
and forHouse
the
Ask For: John Wharton
presentation to local stakeholders and the Local Area Team. This letter provides the Birchwood
response
from Warrington CCG to your Quality Account.
[email protected]
Warrington
th
WA3 7QH
Date:
26
May
2015
The account affirms the work that is being carried out by the trust and which is regularly
th
6 May 2015
Arp
110 Birchwood
Arp
B
W
www.warringtonc
discussed through the mechanisms which we have in place; www.warringtonccg.nhs.uk
contract monitoring, the
established strong focus on quality and the rigorous SUI process are all contributory factors to
ensure that both commissioner and provider are working collaboratively to improve care and
agree appropriate actions and monitoring when the patient experience has not been to the
Esther we
Kirby
standard
all aspire too. I believe that these forums continue to build on our relationship
and
cemented
our united approach to delivering high standards of health care to the local
Executive Nurse
population.
Kirby
Bevan House,
ve Nurse
Warrington
CCG welcomes the work delivered by the Trust in relation to improving patient
care
for the localNHS
population
and wishes to continue the healthy relationship that we have for
Beecham
Court,
water Community17
Healthcare
Trust
future planning of health care delivery. We also wish to congratulate you for the impressive
Smithy
Brook
Road,
House,
work
which
you have
carried out, particularly the intravenous therapy service which has
Pemberton,
impacted
on reducing the length of stay and avoiding admissions for Warrington residents.
cham Court,
The
CCG acknowledges the work undertaken to reduce pressure ulcers the year end position
Wigan.
Brook Road,
of 38% is an increase on the last two years, although it’s difficult to see what is attributable to
WN3 6PR.
rton,
Warrington
and understand the true impact of the work that has taken place this last year.
PR.
sther
uality Account
Warrington CCG also share your disappointment at not meeting your improvement target
regarding the prevention of the risk of future incidents, however acknowledges that this work
Dear
Esther
will
continue
and be built upon in your quality priorities for 2015/2016.
Warrington
CCG Account
welcomes the
feedback which you received from your Care Quality
Re: Quality
2014-2015
Clinical Chief Officer : Dr Andrew Davies MB ChB
Commission (CQC) and are pleased to see the trust declared compliance against the
identified compliance action. The inclusion of your planned Quality Priorities for 2015/16,
Many thanks
the and
submission
QualitytheAccount
2014-2015,
2014-2015
particularly
r sign up for
to safety
the continued of
focusthe
on improving
handling offor
serious
and
untoward incidents
is also
most welcome. and the Local Area Team. This letter provides
presentation
to local
stakeholders
and
the re
Warrington
CCG
to we
your
Quality
Account.
thanks for the Ifrom
submission
of the
Quality
forto 2014-2015,
for the
conclude by informing
you that
are Account
looking forward
working with the and
Trust throughout
ation to local stakeholders
andto the
Local
This
the
response
2015/16, helping
improve
the Area
quality Team.
and delivery
of letter
servicesprovides
for the local
population
and
ensuring
that
the
provider
is
working
towards
delivering
the
three
key
domains
of
the
CCG’S
affirms the work that is being carried out by the trust and which is re
arrington CCG toThe
youraccount
Quality Account.
quality strategy safety, effectiveness and experience remain at the heart of health care
discussed
through
the mechanisms which we have in place; contract monitorin
provision.
focus
on quality
rigorous
SUI process
are all contributory fac
count affirms theestablished
work that strong
is being
carried
out byand
thethe
trust
and which
is regularly
I
believe
that
this
is
an
accurate
and
honest
account
of
your
organisation
and
wish
to
that bothwhich
commissioner
are working
collaboratively
to improve ca
ed through the ensure
mechanisms
we haveand
in provider
place; contract
monitoring,
the
congratulate you on your work.
appropriate
when
the patientfactors
experience
has not been
shed strong focusagree
on quality
and the actions
rigorousand
SUImonitoring
process are
all contributory
to
standard
we
all
aspire
too.
I
believe
that
these
forums
continue
to
build
on our relat
that both commissioner and provider are working collaboratively to improve care and
Yours
sincerely
andand
cemented
our when
unitedthe
approach
deliveringhas
high
of health care to th
appropriate actions
monitoring
patient to
experience
notstandards
been to the
population.
d we all aspire too.
I believe that these forums continue to build on our relationship
mented our united approach to delivering high standards of health care to the local
Warrington CCG welcomes the work delivered by the Trust in relation to improving
ion.
care for the local population and wishes to continue the healthy relationship that we h
future
planning
of health by
care
also to
wish
to congratulate
gton CCG welcomes
the
work delivered
thedelivery.
Trust in We
relation
improving
patient you for the imp
John
Wharton
Chief
Nurse
&
Quality
Lead
work and
which
you to
have
carried
particularly
the intravenous
service whi
r the local population
wishes
continue
theout,
healthy
relationship
that we havetherapy
for
Warrington Clinical Commissioning Group
impacted
on
reducing
the
length
of
stay
and
avoiding
admissions
for
Warrington
res
planning of health care delivery. We also wish to congratulate you for the impressive
The CCG
acknowledges
the work
undertaken
to reduce
pressure
which you 100
have carried
out,
particularly the
intravenous
therapy
service
which ulcers
has the year end p
of 38%
is an
increase
the lastadmissions
two years, for
although
it’s difficult
to see what is attribut
ed on reducing the
length
of stay
and on
avoiding
Warrington
residents.
and understand
the true
impactulcers
of thethe
work
that
hasposition
taken place this last ye
CG acknowledgesWarrington
the work undertaken
to reduce
pressure
year
end
is an increase on the last two years, although it’s difficult to see what is attributable to
T: 01744 624265
F: 01744 624188
Our Ref:
SC/JB / SC1211
2 June 2015
St Helens Chamber
Salisbury Street
Off Chalon Way
St Helens
WA10 1FY
Emailed: [email protected]
Colin Scales
Chief Executive T: 01744 624265
St Helens Chamber
Bridgewater Community Healthcare NHS Foundation Trust
Salisbury Street
Bevan House F: 01744 624188
Off Chalon Way
17 Beecham Court
Our Ref:
SC/JB / SC1211
St Helens
Smithy Brook Road
St Helens Chamber
T: 01744
624265 WN3 6PR
Wigan
WA10 1FY
F: 01744 624188
2 June 2015 Salisbury Street
Off Chalon Way
Dear Colin
Emailed: [email protected]
Our Ref:
SC/JB / SC1211
St Helens
Bridgewater Quality Accounts. WA10 1FY
Colin Scales
2 June 2015
Chief Quality
Executive
Following the recent
Accounts
presentation,
which unfortunately I was unable to
Emailed:
[email protected]
Bridgewater
Community
Healthcare
NHS
Trust
attend, the following
observations
/ comments
were made
by Foundation
Sarah O’Brien
which I would like
Bevan
House
to formally feedback
to yourselves.
The presentation a good presentation, open and honest.
Colin Scales
Chief Executive
17 Beecham Court
Bridgewater
Community
Healthcare
NHS
Foundation
1. We
were pleased
toBrook
note
that
you had Trust
included Newton Hospital as a Quality priority for
Smithy
Road
Bevan House
2015-16 andWigan
look forward toWN3
working
with them on this.
6PR
17 Beecham Court
Smithy2.Brook
Road priority 2 for 2015-16 is relating to improvement in management of serious
Quality
Wigan
WN3 6PRDear Colin
Dear Colin
incidents. We recognise that Bridgewater have already made a lot of improvements this
year and would
like to see more
emphasis
in 2015-16 on learning lessons.
Bridgewater
Quality
Accounts.
3. AllQuality
3 quality
priorities for 2015-16 are very safety focused and it would be good to see
Bridgewater
Accounts.
Following the recent Quality Accounts presentation, which unfortunately I was unable to
some plans relating to experience and effectiveness.
attend, the following observations / comments were made by Sarah O’Brien which I would like
Following the recent Quality Accounts presentation, which unfortunately I was unable to
totoformally
feedback
to yourselves.
The
presentation
a good presentation, open and honest.
Listening
action/ comments
work
you have
a commenced
is excellent.
attend,4.the The
following
observations
were made
by Sarah O’Brien
which I would like
to formally feedback to yourselves. The presentation a good presentation, open and honest.
1.
1. back
Wethat
were
to note that
you
had out
included
Hospital
as a Quality priority for
5. Joe Banat fed
the pleased
work Bridgewater
have
carried
to dateNewton
to improve
access
2015-16
lookthis
forward
tobeHospital
working
with
them
on this.
We were
pleased
to note
that
you and
hadand
included
Newton
as
a Quality
priority
for
to Open
Minds
and
outcomes
should
included
in
the
quality
account.
2015-16 and look forward to working with them on this.
6. We suggested
could
have2 been
a bit more
included toin improvement
the document inabout
2. there
Quality
priority
for 2015-16
is relating
management of serious
2. Qualitysafeguarding
priority 2 forand
2015-16
is and
relating
toBridgewater
improvement
incarrying
management
of serious
staffing
what
outhave
in these
areasmade a lot of improvements this
incidents.
We
recognise
thatare
Bridgewater
already
incidents. We recognise that Bridgewater have already made a lot of improvements this
year
and
would
like
to
see
more
emphasis
in
2015-16
on learning lessons.
year and would like to see more emphasis in 2015-16 on learning lessons.
Yours sincerely,
3.forAll
3 quality
priorities
2015-16
very
and it would be good to see
3. All 3 quality priorities
2015-16
are very
safety for
focused
and itare
would
besafety
good tofocused
see
some plans relating to experience
and effectiveness.
some plans
relating to experience and effectiveness.
4. The Listening to action
have a commenced
is excellent.
4. work
Theyou
Listening
to action work
you have a commenced is excellent.
5. Joe Banat fed back that the work Bridgewater have carried out to date to improve access
5. Joe Banat
back
the work
to Open Minds and outcomes
and thisfed
should
bethat
included
in the Bridgewater
quality account.have carried out to date to improve access
to Open Minds and outcomes and this should be included in the quality account.
6. We suggested there could have been a bit more included in the document about
safeguarding and staffing
and what
Bridgewater
arecould
carryinghave
out in been
these areas
6. We
suggested
there
a bit more included in the document about
Cox safeguarding and staffing and what Bridgewater are carrying out in these areas
Clinical Chief Executive
Yours sincerely,
NHS St Helens CCG
cc
S O’Brien
L Spooner
Dr Stephen
Yours sincerely,
Working in partnership with
and
Dr Stephen Cox
Clinical Chief Executive
NHS St Helens CCG
Dr Stephen Cox
cc
S O’Brien
L Spooner Clinical Chief Executive
NHS St Helens CCG
cc
S O’Brien and
L Spooner
Bridgewaterand
Quality Account 2014/15
101
Appendix A
Children’s Immunisations for Quality Account
Bridgewater
Percentage of
immunisations
delivered on
schedule for
children reaching their
2nd birthday
Primary
13/14
14/15
Diphtheria
97.8%
97.7%
Tetanus
97.8%
97.7%
Pertussis (Whooping Cough)
97.8%
97.7%
Polio
97.8%
97.7%
Haemophilus Influenzae B
97.8%
97.4%
Meningitis C
97.6%
98.3%
Pneumococcal Booster
95.8%
94.7%
MMR
95.6%
94.2%
Primary
13/14
14/15
Diphtheria
97.6%
97.8%
Tetanus
97.6%
97.8%
97.6%
97.8%
Polio
97.6%
97.8%
97.6%
97.7%
Meningitis C
98.1%
98.3%
95.6%
95.3%
MMR
95.3%
94.5%
Ashton, Leigh and Wigan
Percentage of
immunisations
delivered on
schedule for
children reaching their 2nd
birthday
102
Appendix A (continued)
Children’s Immunisations for Quality Account
Halton and St. Helens
Percentage of
immunisations
delivered on
schedule for
birthday
Primary
13/14
14/15
Diphtheria
97.7%
97.4%
Tetanus
97.7%
97.4%
97.7%
97.4%
Polio
97.7%
97.4%
97.7%
96.8%
Meningitis C
96.9%
98.9%
96.5%
94.3%
MMR
96.3%
93.8%
Primary
13/14
14/15
Diphtheria
98.3%
98.1%
Tetanus
98.3%
98.1%
98.3%
98.1%
Polio
98.3%
97.9%
98.2%
97.9%
Meningitis C
97.9%
97.5%
95.1%
94.7%
MMR
94.8%
94.4%
Warrington
Percentage of
immunisations
delivered on
schedule for
birthday
Statement of Directors’ Responsibilities
The directors are required under the Health Act 2009 and the National Health Service (Quality
Accounts) Regulations to prepare Quality Accounts for each financial year.
Monitor has issued guidance to NHS foundation trust boards on the form and content of
annual quality reports (which incorporate the above legal requirements) and on the
arrangements that NHS foundation trust boards should put in place to support the data
quality for the preparation of the quality report.
103
In preparing the Quality Report, directors are required to take steps to satisfy themselves that:
• The content of the Quality Report meets the requirements set out in the NHS
Foundation Trust Annual Reporting Manual 2014/15 and supporting guidance
• The content of the Quality Report is not inconsistent with internal and external sources
of information including:
• Board minutes and papers for the period April 2014 to May 2015
• Papers relating to Quality reported to the board over the period April 2014 to May
2015
• Feedback from commissioners dated May 2015
• Feedback from governors dated May 2015
• Feedback from local Healthwatch organisations dated May 2015
• Feedback from Overview and Scrutiny Committee dated May 2015
• The trust’s complaints report published under regulation 18 of the Local Authority
Social Services and NHS Complaints Regulations 2009.
• The national patient survey – not applicable to community healthcare providers
• The national staff survey 24/02/2015
• The Head of Internal Audit’s annual opinion over the trust’s control environment
dated March 2015
• CQC Intelligent Monitoring Report – not applicable to community healthcare
providers
• The Quality Report presents a balanced picture of the NHS foundation trust’s
performance over the period covered
• The performance information reported in the Quality Report is reliable and accurate
• There are proper internal controls over the collection and reporting of the measures of
performance included in the Quality Report, and these controls are subject to review
to confirm that they are working effectively in practice
• The data underpinning the measures of performance reported in the Quality Report is
robust and reliable, conforms to specified data quality standards and prescribed
definitions, is subject to appropriate scrutiny and review and
• The Quality Report has been prepared in accordance with Monitor’s annual reporting
guidance (which incorporates the Quality Accounts regulations)
(published at www.monitor.gov.uk/annualreportingmanual) as well as the standards to
support data quality for the preparation of the Quality Report
(available at www.monitor.gov.uk/annualreportingmanual).
The directors confirm to the best of their knowledge and belief they have complied with the
above requirements in preparing the Quality Report.
By order of the board
29/5/15
..............................Date.............................................................Chairman
29/5/15
..............................Date.............................................................Chief
Executive
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Bridgewater Community Healthcare
NHS Foundation Trust
Bevan House
17 Beecham Court
Smithy Brook Road
Wigan
WN3 6PR
Tel: 01942 482630 | Fax 01942 482662
Email: [email protected] | www.bridgewater.nhs.uk
www.facebook.com/BridgewaterNHS
www.twitter.com/Bridgewater_NHS
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10. Useful Contacts
Your views
We welcome your comments and feedback on our Annual Report and Accounts and Quality Account.
Please contact 01942 482655 or email [email protected] if you:
• have any further questions or need help understanding any aspect of this document
• would like to view this document in another language or format such as Braille or
audio
• would like us to send you a printed copy of this document or parts of this document
Giving feedback on our services
If you wish to tell us about your experience of our services please contact Patient Services:
Email: [email protected]
Telephone: 0800 587 0562
Membership
If you would like to have a say and help us to develop our services to meet local needs, then
please consider becoming a member. Membership is open to anyone aged 14 years or over who
lives in England. Please contact us to find out more.
Telephone: 01942 482672
Want to know more about us?
You can:
•
•
•
•
find out more about us on our website: www.bridgewater.nhs.uk
follow us on Twitter: www.twitter.com/Bridgewater_NHS
“like” us on Facebook www.facebook.com/BridgewaterNHS
contact our Headquarters:
Bevan House
17 Beecham Court
Smithy Brook Road
Wigan
WN3 6PR.
Telephone: 01942 482630 or
Acknowledgements
Thank you to all the staff and teams who contributed to this document.
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Bridgewater Community Healthcare
NHS Foundation Trust
Bevan House
17 Beecham Court
Smithy Brook Road
Wigan
WN3 6PR
Tel: 01942 482630 | Fax 01942 482662
Email: [email protected] | www.bridgewater.nhs.uk
www.facebook.com/BridgewaterNHS
www.twitter.com/Bridgewater_NHS
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